1.This Act may be cited as the
Caregiver and Veterans Health Services
Act of 2009
.
2.Waiver of charges for
humanitarian care provided to family members accompanying certain severely
injured veterans as they receive medical careThe text of section 1784 of title 38, United
States Code, is amended to read as follows:
(a)The Secretary may furnish hospital care or medical
services as a humanitarian service in emergency cases.
(b)Except
as provided in subsection (c), the Secretary shall charge for care and services
provided under subsection (a) at rates prescribed by the Secretary.
(c)(1)Except as provided in
paragraph (2), the Secretary shall waive the charges required by subsection (b)
for care or services provided under subsection (a) to an attendant of a covered
veteran if such care or services are provided to such attendant for an
emergency that occurs while such attendant is accompanying such veteran while
such veteran is receiving approved inpatient or outpatient treatment at—
(A)a Department
facility; or
(B)a non-Department
facility—
(i)that is under
contract with the Department; or
(ii)at which the
veteran is receiving fee-basis care.
(2)If an attendant is
entitled to care or services under a health-plan contract (as that term is
defined in section 1725(f) of this title) or other contractual or legal
recourse against a third party that would, in part, extinguish liability by
charges described by subsection (b), the amount of such charges waived under
paragraph (1) shall be the amount by which such charges exceed the amount of
such charges covered by the health-plan contract or other contractual or legal
recourse against the third party.
(d)In
this section:
(1)The term
attendant includes, with respect to a veteran, the
following:
(A)A family member of
the veteran.
(B)An individual
eligible to receive ongoing family caregiver assistance under section
1717A(e)(1) of this title for the provision of personal care services to the
veteran.
(C)Any other
individual whom the Secretary determines—
(i)has a relationship
with the veteran sufficient to demonstrate a close affinity with the veteran;
and
(ii)provides a
significant portion of the veteran's care.
(2)The term
covered veteran means any veteran with a severe injury incurred or
aggravated in the line of duty in the active military, naval, or air service on
or after September 11, 2001.
(3)The term
family member with respect to a veteran, includes the
following:
(A)The spouse of the
veteran.
(B)The child of the
veteran.
(C)A parent of the
veteran.
(D)A sibling of the
veteran.
(E)A cousin of the
veteran.
(F)An aunt of the
veteran.
(G)An uncle of the
veteran.
(H)A grandparent of
the veteran.
(I)A grandchild of
the veteran.
(J)A stepparent of
the veteran.
(K)A stepchild of the
veteran.
(L)A stepsibling of
the veteran.
(M)A parent-in-law of
the veteran.
(N)A sister-in-law of
the veteran.
(O)A brother-in-law
of the veteran.
(P)A cousin of the
spouse of the veteran.
(Q)An aunt of the
spouse of the veteran.
(R)An uncle of the
spouse of the veteran.
(S)A grandparent of
the spouse of the veteran.
(T)A grandchild of
the spouse of the veteran.
(U)A stepparent of
the spouse of the veteran.
(V)A stepsibling of
the spouse of the veteran.
(W)Such other
individuals as the Secretary shall specify in regulations for purposes of this
section.
(4)The term
severe injury means, in the case of a covered veteran, any injury
as follows:
(A)A physiological
condition of the veteran if the condition is a permanent or temporary severely
disabling disorder that compromises the ability of the veteran to carry out one
or more independent activities of daily living.
(B)A psychological
condition of the veteran if the condition is rated at 30 or less on the Global
Assessment of Functioning (GAF) scale, as set forth in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Text Revision
(DSM–IV–TR), or the most recent edition if different than the Fourth Edition
Text Revision, of the American Psychiatric Association.
(C)An injury for
which the veteran needs supervision or protection based on symptoms or
residuals of neurological or other impairment.
(D)Any other injury
of the veteran that is determined to be a severe injury in accordance with
regulations prescribed by the Secretary for purposes of this
section.
.
3.Family caregiver
assistance
(a)
(1)Subchapter II of chapter 17 of title 38, United States
Code, is amended by inserting after section 1717 the following new
section:
1717A.Family
caregiver assistance
(a)(1)As part of home health
services provided under section 1717 of this title, the Secretary shall, upon
the joint application of an eligible veteran and a family member of such
veteran (or other individual designated by such veteran), furnish to such
family member (or designee) family caregiver assistance in accordance with this
section. The purpose of providing family caregiver assistance under this
section is—
(A)to reduce the
number of veterans who are receiving institutional care, or who are in need of
institutional care, whose personal care service needs could be substantially
satisfied with the provision of such services by a family member (or designee);
and
(B)to provide
eligible veterans with additional options so that they can choose the setting
for the receipt of personal care services that best suits their needs.
(2)The Secretary
shall only furnish family caregiver assistance under this section to a family
member of an eligible veteran (or other individual designated by such veteran)
if the Secretary determines it is in the best interest of the eligible veteran
to do so.
(b)(1)For purposes of this
section, an eligible veteran is a veteran (or member of the Armed Forces
undergoing medical discharge from the Armed Forces)—
(A)who has a serious
injury (including traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in line of duty in the active military, naval,
or air service on or after the date described in paragraph (2); and
(B)whom the Secretary
determines, in consultation with the Secretary of Defense as necessary, is in
need of personal care services because of—
(i)an inability to
perform one or more independent activities of daily living;
(ii)a need for
supervision or protection based on symptoms or residuals of neurological or
other impairment or injury; or
(iii)such other
matters as the Secretary shall establish in consultation with the Secretary of
Defense as appropriate.
(2)The date described
in this paragraph—
(A)during the period
beginning on the date of the enactment of the Caregiver and Veterans Health Services Act of
2009 and ending two years after the date of the enactment of that
Act, is September 11, 2001; and
(B)beginning on the
first day after the date that is two years after the date of the enactment of
the Caregiver and Veterans Health Services
Act of 2009, is the earliest date the Secretary determines is
appropriate to include the largest number of veterans possible under this
section without reducing the quality of care provided to such veterans.
(c)Evaluation of
eligible veterans and family caregivers(1)The Secretary shall
evaluate each eligible veteran who makes a joint application under subsection
(a)(1)—
(A)to identify the
personal care services required by such veteran; and
(B)to determine
whether such requirements could be significantly or substantially satisfied
with the provision of personal care services from a family member (or other
individual designated by the veteran).
(2)The Secretary
shall evaluate each family member of an eligible veteran (or other individual
designated by the veteran) who makes a joint application under subsection
(a)(1) to determine—
(A)the basic amount
of instruction, preparation, and training such family member (or designee)
requires, if any, to provide the personal care services required by such
veteran; and
(B)the amount of
additional instruction, preparation, and training such family member (or
designee) requires, if any, to be the primary personal care attendant
designated for such veteran under subsection (e).
(3)An evaluation
carried out under paragraph (1) may be carried out—
(A)at a Department
facility;
(B)at a
non-Department facility determined appropriate by the Secretary for purposes of
such evaluation; and
(C)such other
locations as the Secretary considers appropriate.
(d)Training and
certification(1)Except as provided in
subsection (a)(2), the Secretary shall provide each family member of an
eligible veteran (or other individual designated by the veteran) who makes a
joint application under subsection (a)(1) the basic instruction, preparation,
and training determined to be required by such family member (or designee)
under subsection (c)(2)(A).
(2)The Secretary may
provide to a family member of an eligible veteran (or other individual
designated by the veteran) the additional instruction, preparation, and
training determined to be required by such family member (or designee) under
subsection (c)(2)(B) if such family member (or designee)—
(A)is certified as a
personal care attendant for the veteran under paragraph (3); and
(B)requests, with
concurrence of the veteran, such additional instruction, preparation, and
training.
(3)Upon the
successful completion by a family member of an eligible veteran (or other
individual designated by the veteran) of basic instruction, preparation, and
training provided under paragraph (1), the Secretary shall certify the family
member as a personal care attendant for the veteran.
(4)If the Secretary
determines that a primary personal care attendant designated under subsection
(e) requires additional training to maintain such designation, the Secretary
shall make such training available to the primary personal care
attendant.
(5)The Secretary
shall, subject to regulations the Secretary shall prescribe, provide for
necessary travel, lodging, and per diem expenses incurred by a family member of
an eligible veteran (or other individual designated by the veteran) in
undergoing training under this subsection.
(6)If the
participation of a family member of an eligible veteran (or other individual
designated by the veteran) in training under this subsection would interfere
with the provision of personal care services to the veteran, the Secretary
shall, subject to regulations as the Secretary shall prescribe and in
consultation with the eligible veteran, provide respite care to the eligible
veteran during the provision of such training to the family member so that such
family caregiver (or designee) can participate in such training without
interfering with the provision of such services.
(e)Designation of
primary personal care attendant(1)For each eligible
veteran with at least one family member (or other individual designated by the
veteran) who is described by subparagraphs (A) through (E) of paragraph (2),
the Secretary shall designate one family member of such veteran (or other
individual designated by the veteran) as the primary personal care attendant
for such veteran to be the primary provider of personal care services for such
veteran.
(2)A primary personal
care attendant designated for an eligible veteran under paragraph (1) shall be
selected from among family members of such veteran (or other individuals
designated by such veteran) who—
(A)are certified
under subsection (d)(3) as a personal care attendant for such veteran;
(B)complete all
additional instruction, preparation, and training, if any, provided under
subsection (d)(2);
(C)elect to provide
the personal care services to such veteran that the Secretary determines such
veteran requires under subsection (c)(1);
(D)has the consent of
such veteran to be the primary provider of such services for such veteran;
and
(E)the Secretary
considers competent to be the primary provider of such services for such
veteran.
(3)An eligible
veteran receiving personal care services from a family member (or other
individual designated by the veteran) designated as the primary personal care
attendant for the veteran under paragraph (1) may revoke consent with respect
to such family member (or designee) under paragraph (2)(D) at any time.
(4)If an individual
designated as the primary personal care attendant of an eligible veteran under
paragraph (1) subsequently fails to meet the requirements set forth in
paragraph (2), the Secretary—
(A)shall immediately
revoke the individual's designation under paragraph (1); and
(B)may designate, in
consultation with the eligible veteran or the eligible veteran's surrogate
appointed under subsection (g), a new primary personal care attendant for the
veteran under such paragraph.
(5)The Secretary
shall take such actions as may be necessary to ensure that the revocation of a
designation under paragraph (1) does not interfere with the provision of
personal care services required by a veteran.
(f)Ongoing family
caregiver assistance(1)Except as provided in
subsection (a)(2) and subject to the provisions of this subsection, the
Secretary shall provide ongoing family caregiver assistance to family members
of eligible veterans (or other individuals designated by such veterans) as
follows:
(A)To each family
member of an eligible veteran (or designee) who is certified under subsection
(d)(3) as a personal care attendant for the veteran the following:
(i)Direct technical
support consisting of information and assistance to timely address routine,
emergency, and specialized caregiving needs.
(ii)Counseling.
(iii)Access to an
interactive Internet website on caregiver services that addresses all aspects
of the provision of personal care services under this section.
(B)To each family
member of an eligible veteran (or designee) who is designated as the primary
personal care attendant for the veteran under subsection (e) the
following:
(i)The ongoing family
caregiver assistance described in subparagraph (A).
(ii)Mental health
services.
(iii)Respite care of
not less than 30 days annually, including 24-hour per day care of the veteran
commensurate with the care provided by the family caregiver to permit extended
respite.
(iv)Medical care
under section 1781 of this title.
(v)A monthly personal
caregiver stipend.
(2)(A)The Secretary shall
provide respite care under paragraph (1)(B)(iii), at the election of the
Secretary—
(i)through facilities
of the Department that are appropriate for the veteran; or
(ii)through contracts
under section 1720B(c) of this title.
(B)If the primary
personal care attendant of an eligible veteran designated under subsection
(e)(1) determines in consultation with the veteran or the veteran's surrogate
appointed under subsection (g), and the Secretary concurs, that the needs of
the veteran cannot be accommodated through the facilities and contracts
described in subparagraph (A), the Secretary shall, in consultation with the
primary personal care attendant and the veteran (or the veteran's surrogate),
provide respite care through other facilities or arrangements that are
medically and age appropriate.
(3)(A)The Secretary shall
provide monthly personal caregiver stipends under paragraph (1)(B)(v) in
accordance with a schedule established by the Secretary that specifies stipends
provided based upon the amount and degree of personal care services
provided.
(B)The Secretary
shall ensure, to the extent practicable, that the schedule required by
subparagraph (A) specifies that the amount of the personal caregiver stipend
provided to a primary personal care attendant designated under subsection
(e)(1) for the provision of personal care services to an eligible veteran is
not less than the amount the Secretary would pay a commercial home health care
entity in the geographic area of the veteran to provide equivalent personal
care services to the veteran.
(C)If personal care
services are not available from a commercial provider in the geographic area of
an eligible veteran, the Secretary may establish the schedule required by
subparagraph (A) with respect to the veteran by considering the costs of
commercial providers of personal care services in geographic areas other than
the geographic area of the veteran with similar costs of living.
(4)Provision of
ongoing family caregiver assistance under this subsection for provision of
personal care services to an eligible veteran shall terminate if the eligible
veteran no longer requires the personal care services.
(g)If
an eligible veteran lacks the capacity to submit an application, provide
consent, make a request, or concur with a request under this section, the
Secretary may, in accordance with regulations and policies of the Department
regarding the appointment of guardians or the use of powers of attorney,
appoint a surrogate for the veteran who may submit applications, provide
consent, make requests, or concur with requests on behalf of the veteran under
this section.
(h)(1)The Secretary shall
enter into contracts with appropriate entities to provide oversight of the
provision of personal care services by primary personal care attendants
designated under subsection (e)(1) under this section.
(2)The Secretary
shall ensure that each eligible veteran receiving personal care services under
this section from a primary personal care attendant designated under subsection
(e)(1) is visited in the veteran's home by an entity providing oversight under
paragraph (1) at such frequency as the Secretary shall determine under
paragraph (3) to determine if the care received by the veteran under this
section meets the needs of the veteran.
(3)(A)Except as provided in
subparagraph (B), the Secretary shall determine the manner of oversight
provided under paragraph (1) and the frequency of visits under paragraph (2)
for an eligible veteran as the Secretary considers commensurate with the needs
of such eligible veteran.
(B)The frequency of
visits under paragraph (2) for an eligible veteran shall be not less frequent
than once every six months.
(4)(A)An entity visiting an
eligible veteran under paragraph (2) shall submit to the Secretary the findings
of the entity with respect to each visit, including whether the eligible
veteran is receiving the care the eligible veteran requires.
(B)If an entity finds
under subparagraph (A) that an eligible veteran is not receiving the care the
eligible veteran requires, the entity shall submit to the Secretary a
recommendation on the corrective actions that should be taken to ensure that
the eligible veteran receives the care the eligible veteran requires,
including, if the entity considers appropriate, a recommendation for revocation
of a caregiver's certification under subsection (d)(3) or revocation of the
designation of an individual under subsection (e)(1).
(5)After receiving
findings and recommendations, if any, under paragraph (4) with respect to an
eligible veteran, the Secretary may take such actions as the Secretary
considers appropriate to ensure that the eligible veteran receives the care the
eligible veteran requires, including the following:
(A)Revocation of a
caregiver's certification under subsection (d)(3).
(B)Revocation of the
designation of an individual under subsection (e)(1).
(6)If the Secretary
terminates the provision of ongoing family caregiver assistance under
subsection (f) to a family member of an eligible veteran (or other individual
designated by the veteran) because of findings of an entity submitted to the
Secretary under paragraph (4) of this subsection, the Secretary may not provide
compensation to such entity for the provision of personal care services to such
veteran, unless the Secretary determines it would be in the best interest of
the eligible veteran to provide compensation to such entity to provide such
services.
(i)The
Secretary shall carry out a program of outreach to inform eligible veterans and
their family members of the availability and nature of family caregiver
assistance.
(j)A
decision by the Secretary under this section affecting the furnishing of family
caregiver assistance shall be considered a medical determination.
(k)In
this section:
(1)The term
family caregiver assistance includes the instruction, preparation,
training, and certification provided under subsection (d) and the ongoing
family caregiver assistance provided under subsection (f).
(2)The term
family member includes, with respect to a veteran, the
following:
(A)The spouse of the
veteran.
(B)The child of the
veteran.
(C)A parent of the
veteran.
(D)A sibling of the
veteran.
(E)A cousin of the
veteran.
(F)An aunt of the
veteran.
(G)An uncle of the
veteran.
(H)A grandparent of
the veteran.
(I)A grandchild of
the veteran.
(J)A stepparent of
the veteran.
(K)A stepchild of the
veteran.
(L)A stepsibling of
the veteran.
(M)A parent-in-law of
the veteran.
(N)A sister-in-law of
the veteran.
(O)A brother-in-law
of the veteran.
(P)A cousin of the
spouse of the veteran.
(Q)An aunt of the
spouse of the veteran.
(R)An uncle of the
spouse of the veteran.
(S)A grandparent of
the spouse of the veteran.
(T)A grandchild of
the spouse of the veteran.
(U)A stepparent of
the spouse of the veteran.
(V)A stepsibling of
the spouse of the veteran.
(W)Such other
individuals as the Secretary shall specify in regulations for purposes of this
section.
(3)The term
personal care services includes the following:
(A)Supervision.
(B)Protection.
(C)Services to assist
a veteran with one or more independent activities of daily living.
(D)Such other
services as the Secretary considers
appropriate.
.
(2)The table of sections at the beginning of chapter 17 of
such title is amended by inserting after the item related to section 1717 the
following new item:
1717A. Family caregiver
assistance.
.
(3)Authorization
for provision of health care to personal care attendantsSection
1781(a) of such title is amended—
(A)by redesignating
paragraphs (2) and (3) as paragraphs (3) and (4), respectively; and
(B)by inserting after
paragraph (1) the following new paragraph (2):
(2)a family member of
a veteran (or other individual designated by the veteran) designated as the
primary personal care attendant for such veteran under section 1717A(e) of this
title,
.
(4)The
furnishing of family caregiver assistance under section 1717A of title 38,
United States Code, as added by paragraph (1), shall be construed to supplement
and not supplant the programs of the Department of Veterans Affairs in
existence on the date of the enactment of this Act.
(5)The amendments made by this subsection shall take effect on
the date that is 270 days after the date of the enactment of this Act.
(b)Implementation
plan and report
(1)Not later than 180 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall—
(A)develop a plan for
the implementation of section 1717A of title 38, United States Code, as added
by subsection (a)(1); and
(B)submit to the
Committee on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a report on such plan.
(2)In
developing the plan required by paragraph (1)(A), the Secretary shall consult
with the following:
(A)Veterans described
in section 1717A(b) of title 38, United States Code, as added by subsection
(a)(1).
(B)Family members of
veterans who provide personal care services to such veterans.
(C)Veterans service
organizations, as recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38, United States
Code.
(D)Relevant national
organizations that specialize in the provision of assistance to individuals
with the types of disabilities that personal care attendants will encounter
while providing personal care services under section 1717A of title 38, United
States Code, as so added.
(E)Such other
organizations with an interest in the provision of care to veterans as the
Secretary considers appropriate.
(F)The Secretary of
Defense with respect to matters concerning personal care services for eligible
veterans who are members of the Armed Forces undergoing medical discharge from
the Armed Forces.
(3)The report required by paragraph (1)(B) shall contain
the following:
(A)The plan required
by paragraph (1)(A).
(B)A description of
the veterans, caregivers, and organizations consulted by the Secretary under
paragraph (2).
(C)A description of
such consultations.
(D)The
recommendations of such veterans, caregivers, and organizations, if any, that
were not incorporated into the plan required by paragraph (1)(A).
(E)The reasons the
Secretary did not incorporate such recommendations into such plan.
(c)
(1)Not later than two years after the date described in
subsection (a)(4) and annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a comprehensive report on the
implementation of section 1717A of title 38, United States Code, as added by
subsection (a)(1).
(2)The
report required by paragraph (1) shall include the following:
(A)The number of
family members of veterans (or other individuals designated by veterans) that
received family caregiver assistance under such section 1717A.
(B)A description of
the outreach activities carried out by the Secretary in accordance with
subsection (i) of such section 1717A.
(C)The resources
expended by the Secretary under such section 1717A.
(D)An assessment of
the manner in which resources are expended by the Secretary under such section
1717A, particularly with respect to the provision of monthly personal caregiver
stipends under subsection (f) of such section.
(E)A description of
the outcomes achieved by, and any measurable benefits of, carrying out the
requirements of such section 1717A.
(F)A justification of
any determination made under subsection (b)(2) of such section 1717A.
(G)An assessment of
the effectiveness and the efficiency of the implementation of such section
1717A.
(H)An assessment of
how the provision of family caregiver assistance fits into the continuum of
home health care services and benefits provided to veterans in need of such
services and benefits.
(I)Such
recommendations, including recommendations for legislative or administrative
action, as the Secretary considers appropriate in light of carrying out the
requirements of such section 1717A.
4.Lodging and
subsistence for attendantsSection 111(e) of title 38, United States
Code, is amended—
(1)by striking When any
and
inserting (1) When any
;
(2)in paragraph (1),
as designated by paragraph (1) of this subsection—
(A)by inserting
(including lodging and subsistence)
after expenses of
travel
; and
(B)by inserting
before the period at the end the following: for the period consisting of
travel to and from a treatment facility and the duration of the treatment
episode
; and
(3)by adding at the
end the following:
(2)The Secretary may
prescribe regulations to carry out this subsection. Such regulations may
include provisions—
(A)to limit the
number of individuals that may receive expenses of travel under paragraph (1)
for a single treatment episode of a person; and
(B)to require
attendants to use certain travel services.
(3)In this
subsection:
(A)The term
attendant includes, with respect to a person described in
paragraph (1), the following:
(i)A family member of
the person.
(ii)An individual
certified as a personal care attendant under section 1717A(d)(3) of this
title.
(iii)Any other
individual whom the Secretary determines—
(I)has a preexisting
relationship with the person; and
(II)provides a
significant portion of the person's care.
(B)The term
family member includes, with respect to a person described in
paragraph (1), the following:
(i)The spouse of the
person.
(ii)The child of the
person.
(iii)A parent of the
person.
(iv)A sibling of the
person.
(v)A cousin of the
person.
(vi)An aunt of the
person.
(vii)An uncle of the
person.
(viii)A grandparent
of the person.
(ix)A grandchild of
the person.
(x)A stepparent of
the person.
(xi)A stepchild of
the person.
(xii)A stepsibling of
the person.
(xiii)A parent-in-law
of the person.
(xiv)A sister-in-law
of the person.
(xv)A brother-in-law
of the person.
(xvi)A cousin of the
spouse of the person.
(xvii)An aunt of the
spouse of the person.
(xviii)An uncle of
the spouse of the person.
(xix)A grandparent of
the spouse of the person.
(xx)A grandchild of
the spouse of the person.
(xxi)A stepparent of
the spouse of the person.
(xxii)A stepsibling
of the spouse of the person.
(xxiii)Such other
individuals as the Secretary shall specify in regulations for purposes of this
subsection.
.
1.Short title; table of
contents
(a)This Act may be cited
as the Caregiver and Veterans Health
Services Act of 2009
.
(b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. References to title 38, United States
Code.
TITLE I—Caregiver
support
Sec. 101. Waiver of charges for humanitarian
care provided to family members accompanying certain severely injured veterans
as they receive medical care.
Sec. 102. Family caregiver
assistance.
Sec. 103. Lodging and subsistence for
attendants.
Sec. 104. Survey of informal
caregivers.
TITLE II—Rural health
improvements
Sec. 201. Enhancement of Department of Veterans
Affairs Education Debt Reduction Program.
Sec. 202. Visual impairment and orientation and
mobility professionals education assistance program.
Sec. 203. Inclusion of Department of Veterans
Affairs facilities in list of facilities eligible for assignment of
participants in National Health Service Corps Scholarship Program.
Sec. 204. Teleconsultation and
telemedicine.
Sec. 205. Demonstration projects on
alternatives for expanding care for veterans in rural areas.
Sec. 206. Program on provision of readjustment
and mental health care services to veterans who served in Operation Iraqi
Freedom and Operation Enduring Freedom.
Sec. 207. Improvement of care of American
Indian veterans.
Sec. 208. Travel reimbursement for veterans
receiving treatment at facilities of the Department of Veterans
Affairs.
Sec. 209. Office of Rural Health five-year
strategic plan.
Sec. 210. Oversight of contract and fee-basis
care.
Sec. 211. Enhancement of Vet Centers to meet
needs of veterans of Operation Iraqi Freedom and Operation Enduring
Freedom.
Sec. 212. Centers of excellence for rural
health research, education, and clinical activities.
Sec. 213. Pilot program on incentives for
physicians who assume inpatient responsibilities at community hospitals in
health professional shortage areas.
Sec. 214. Annual report on matters related to
care for veterans who live in rural areas.
Sec. 215. Transportation grants for rural
veterans service organizations.
TITLE III—Other health care
matters
Sec. 301. Expansion of veteran eligibility for
reimbursement by Secretary of Veterans Affairs for emergency treatment
furnished in a non-Department facility.
Sec. 302. Prohibition on collection of
copayments from veterans who are catastrophically disabled.
TITLE IV—Construction and naming
matters
Sec. 401. Major medical facility project
Department of Veterans Affairs Medical Center, Walla Walla,
Washington.
Sec. 402. Merril Lundman Department of Veterans
Affairs Outpatient Clinic.
2.References to title 38,
United States CodeExcept as
otherwise expressly provided, whenever in this Act an amendment or repeal is
expressed in terms of an amendment to, or repeal of, a section or other
provision, the reference shall be considered to be made to a section or other
provision of title 38, United States Code.
<enum>I</enum><header>Caregiver
support</header>
<section id="idE51C6F0824044F42964C4B2D6291A119" section-type="subsequent-section"><enum>101.</enum><header>Waiver of charges
for humanitarian care provided to family members accompanying certain severely
injured veterans as they receive medical care</header><text display-inline="no-display-inline">The text of section 1784 is amended to read
as follows:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idF7E9BBDF7C5444B482AC668562663DC2" reported-display-style="italic" style="USC">
<subsection id="id12BF35F10DD643718F0DB67C1F61116F"><enum>(a)</enum><header>In
general</header><text>The Secretary may furnish hospital care or medical
services as a humanitarian service in emergency cases.</text>
</subsection><subsection id="idC73D6C3779234D1A93954C97A85D7AE2"><enum>(b)</enum><header>Reimbursement</header><text>Except
as provided in subsection (c), the Secretary shall charge for care and services
provided under subsection (a) at rates prescribed by the Secretary.</text>
</subsection><subsection id="id986F8A68D94E4BD9A71513D327108742"><enum>(c)</enum><header>Waiver of
charges</header><paragraph commented="no" display-inline="yes-display-inline" id="id1C48C16A4D234BD1A366B512C253321B"><enum>(1)</enum><text>Except as provided in
paragraph (2), the Secretary shall waive the charges required by subsection (b)
for care or services provided under subsection (a) to an attendant of a covered
veteran if such care or services are provided to such attendant for an
emergency that occurs while such attendant is accompanying such veteran while
such veteran is receiving approved inpatient or outpatient treatment at—</text>
<subparagraph changed="added" committee-id="SSVA00" id="idC1F4746D626841AF88207885438B0F2C" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>a Department facility;
or</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id980864444F7945BBAFCBAC39EC2F6CB1" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>a non-Department
facility—</text>
<clause id="id2715F9BD9CE4435886BC67CFF1B8D0AE"><enum>(i)</enum><text>that is under contract
with the Department; or</text>
</clause><clause id="id00EAB6DE2553415FAD67C4B7FC2E4B87"><enum>(ii)</enum><text>at which the veteran is
receiving fee-basis care.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id9A313AE1FC2D4F54976A9D68BA5672DF" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>If an attendant is
entitled to care or services under a health-plan contract (as that term is
defined in section 1725(f) of this title) or other contractual or legal
recourse against a third party that would, in part, extinguish liability for
charges described by subsection (b), the amount of such charges waived under
paragraph (1) shall be the amount by which such charges exceed the amount of
such charges covered by the health-plan contract or other contractual or legal
recourse against the third party.</text>
</paragraph></subsection><subsection id="idC21901BBE7004AB196B66FC0A50F9209"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="id5AB24FD8874F44378BA14A2C87BD3F03"><enum>(1)</enum><text>The term
<term>attendant</term>, with respect to a veteran, includes the
following:</text>
<subparagraph id="id23B5E9BA5B114869AD3BC07131931549"><enum>(A)</enum><text>A family member of the
veteran.</text>
</subparagraph><subparagraph id="id33E7BF26B861441B9065D3504C902294"><enum>(B)</enum><text>An individual eligible to
receive ongoing family caregiver assistance under section 1717A(e)(1) of this
title for the provision of personal care services to the veteran.</text>
</subparagraph><subparagraph id="id20892A85303E4C91B9037ED3F193B2F6"><enum>(C)</enum><text>Any other individual whom
the Secretary determines—</text>
<clause id="id2BE13DE1313F4047947D6FE0AFFE3233"><enum>(i)</enum><text>has a relationship with
the veteran sufficient to demonstrate a close affinity with the veteran;
and</text>
</clause><clause id="idF6AEF15CF76543FA84C4712DAA3AD92D"><enum>(ii)</enum><text>provides a significant
portion of the veteran's care.</text>
</clause></subparagraph></paragraph><paragraph id="idEB138FE1645144A6B0ACB083D083B6E0"><enum>(2)</enum><text>The term <term>covered
veteran</term> means any veteran with a severe injury incurred or aggravated in
the line of duty in the active military, naval, or air service on or after
September 11, 2001.</text>
</paragraph><paragraph id="id6BE6BEF048E84097AA6E7A549F059EF2"><enum>(3)</enum><text>The term <term>family
member</term> shall have such meaning as the Secretary shall determine by
policy or regulation.</text>
</paragraph><paragraph id="id79766763B8C04DB8982435D8E84E134F"><enum>(4)</enum><text>The term <term>severe
injury</term>, in the case of a covered veteran, means any physiological,
psychological, or neurological condition that renders a veteran unable to live
independently as determined by the
Secretary.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="id61D1FAE163164A31B35D1DF20FE5BC58"><enum>102.</enum><header>Family caregiver
assistance</header>
<subsection id="id02A21AC1A55947DEB4B4B365213C21C2"><enum>(a)</enum><header>Requirement</header>
<paragraph id="id09CEA2A43BF44B5D9D41CF3EE5059F7D"><enum>(1)</enum><header>In
general</header><text>Subchapter II of chapter 17 is amended by inserting after
section 1717 the following new section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idD2E2D809E66145BF9D821391625EEAE6" reported-display-style="italic" style="USC">
<section id="id00635820A2DC494688CF800A9DFF0FDF"><enum>1717A.</enum><header>Family caregiver
assistance</header>
<subsection id="id78F6FCE8C46A47B5A04B787BA7491079"><enum>(a)</enum><header>In
general</header><paragraph commented="no" display-inline="yes-display-inline" id="id6515A18B52C145D6B60789944703F28C"><enum>(1)</enum><text>As part of home health
services provided under section 1717 of this title, the Secretary shall, upon
the joint application of an eligible veteran and a family member of such
veteran (or other individual designated by such veteran), furnish to such
family member (or designee) family caregiver assistance in accordance with this
section. The purpose of providing family caregiver assistance under this
section is—</text>
<subparagraph changed="added" committee-id="SSVA00" id="id7840146FBD14480D9CAB76502653E0DA" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>to reduce the number of
veterans who are receiving institutional care, or who are in need of
institutional care, whose personal care service needs could be substantially
satisfied with the provision of such services by a family member (or designee);
and</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id2CECEE966B734E598927E86D1042E701" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>to provide eligible
veterans with additional options so that they can choose the setting for the
receipt of personal care services that best suits their needs.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idBB3E93E4900E4227BFB9075D3B75B0B3" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall only
furnish family caregiver assistance under this section to a family member of an
eligible veteran (or other individual designated by such veteran) if the
Secretary determines it is in the best interest of the eligible veteran to do
so.</text>
</paragraph></subsection><subsection id="idB05E35AA6E62434CA460B064B3D99EC9"><enum>(b)</enum><header>Eligible
veterans</header><paragraph commented="no" display-inline="yes-display-inline" id="id837B2D44CFC346DDA224680448C83561"><enum>(1)</enum><text>For purposes of this
section, an eligible veteran is a veteran (or member of the Armed Forces
undergoing medical discharge from the Armed Forces)—</text>
<subparagraph changed="added" committee-id="SSVA00" id="id4010245052C34891838B0474FAD53F0B" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>who has a serious injury
(including traumatic brain injury, psychological trauma, or other mental
disorder) incurred or aggravated in the line of duty in the active military,
naval, or air service on or after the date described in paragraph (2);
and</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id377DF283749540F2B2E225660010E4CD" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>whom the Secretary
determines, in consultation with the Secretary of Defense as necessary, is in
need of personal care services because of—</text>
<clause id="idE399EA7DA36F433D97E5DB9C9EBCD93A"><enum>(i)</enum><text>an inability to perform
one or more independent activities of daily living;</text>
</clause><clause id="idD394392A13D54923B95D5E3B3E5F5200"><enum>(ii)</enum><text>a need for supervision
or protection based on symptoms or residuals of neurological or other
impairment or injury; or</text>
</clause><clause id="id9EE491A314704F54844CB7E74E8B246B"><enum>(iii)</enum><text>such other matters as
the Secretary shall establish in consultation with the Secretary of Defense as
appropriate.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idD1758C8081DD4721BA922B8C655182D4" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The date described in
this paragraph—</text>
<subparagraph id="id2D41535EBB6B4ED0902909CC23D4BDF4"><enum>(A)</enum><text>during the period
beginning on the date of the enactment of the <short-title>Caregiver and Veterans Health Services Act of
2009</short-title> and ending two years after the date of the enactment of that
Act, is September 11, 2001; and</text>
</subparagraph><subparagraph id="id91F88065972B440689970DB3BAA04021"><enum>(B)</enum><text>beginning on the first
day after the date that is two years after the date of the enactment of the
<short-title>Caregiver and Veterans Health Services Act of
2009</short-title>, is the earliest date the Secretary determines is
appropriate to include the largest number of veterans (and members of the Armed
Forces) possible under this section without reducing the quality of care
provided to such veterans (and members).</text>
</subparagraph></paragraph></subsection><subsection id="id5634E0C9F95D469CBBA0E3E4B4091DBB"><enum>(c)</enum><header>Evaluation of eligible
veterans and family caregivers</header><paragraph commented="no" display-inline="yes-display-inline" id="id1C0253A5053449109B118D73C458F371"><enum>(1)</enum><text>The Secretary shall
evaluate each eligible veteran who makes a joint application under subsection
(a)(1)—</text>
<subparagraph changed="added" committee-id="SSVA00" id="id856FAF632B384F508D5920E34218DF1F" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>to identify the personal
care services required by such veteran; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id7C0777E8473641558849988F16F88A48" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>to determine whether such
requirements could be significantly or substantially satisfied with the
provision of personal care services from a family member (or other individual
designated by the veteran).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idBB275FD1B78B43248AB418FA9BE83FB9" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall
evaluate each family member of an eligible veteran (or other individual
designated by the veteran) who makes a joint application under subsection
(a)(1) to determine—</text>
<subparagraph id="idBD88CDB3E55841C2856D3E9F5753D97A"><enum>(A)</enum><text>the basic amount of
instruction, preparation, and training such family member (or designee)
requires, if any, to provide the personal care services required by such
veteran; and</text>
</subparagraph><subparagraph id="id86EFE1B8B0EB40F78576DF69DB8A2BD8"><enum>(B)</enum><text>the amount of additional
instruction, preparation, and training such family member (or designee)
requires, if any, to be the primary personal care attendant designated for such
veteran under subsection (e).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idB245E92C1B934B4899BB115AFCAE27AA" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>An evaluation carried out
under paragraph (1) may be carried out—</text>
<subparagraph id="id053E33D274CE4AD79565DDFE94CD0309"><enum>(A)</enum><text>at a Department
facility;</text>
</subparagraph><subparagraph id="id4D11D0A302394B2D9546C5DEF050ECC5"><enum>(B)</enum><text>at a non-Department
facility determined appropriate by the Secretary for purposes of such
evaluation; and</text>
</subparagraph><subparagraph id="id8AB5C100E31F423C92F17F0B31FEED5A"><enum>(C)</enum><text>at such other locations
as the Secretary considers appropriate.</text>
</subparagraph></paragraph></subsection><subsection id="id287BD000ACF34DC9873F595DF4F5088C"><enum>(d)</enum><header>Training and
approval</header><paragraph commented="no" display-inline="yes-display-inline" id="id263BC653EADC4D64934E430F82B60076"><enum>(1)</enum><text>Except as provided in
subsection (a)(2), the Secretary shall provide each family member of an
eligible veteran (or other individual designated by the veteran) who makes a
joint application under subsection (a)(1) the basic instruction, preparation,
and training determined to be required by such family member (or designee)
under subsection (c)(2)(A).</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idAAB316C58ED543A3886D2EDC6D7D8C8E" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary may provide
to a family member of an eligible veteran (or other individual designated by
the veteran) the additional instruction, preparation, and training determined
to be required by such family member (or designee) under subsection (c)(2)(B)
if such family member (or designee)—</text>
<subparagraph id="id9F331F37BBCB4042ACBA12D67CA7E825"><enum>(A)</enum><text>is approved as a personal
care attendant for the veteran under paragraph (3); and</text>
</subparagraph><subparagraph id="id3E11AF4E0EA74D36BF6921D66DF94F76"><enum>(B)</enum><text>requests, with
concurrence of the veteran, such additional instruction, preparation, and
training.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id0A2A440EB8BF4ACAAB607481727728B6" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>Upon the successful
completion by a family member of an eligible veteran (or other individual
designated by the veteran) of basic instruction, preparation, and training
provided under paragraph (1), the Secretary shall approve the family member as
a personal care attendant for the veteran.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id0A39282166454C2D9217BF3780CACD73" indent="up1" reported-display-style="italic"><enum>(4)</enum><text>If the Secretary
determines that a primary personal care attendant designated under subsection
(e) requires additional training to maintain such designation, the Secretary
shall make such training available to the primary personal care
attendant.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idC44B287B850D411B950DE4259F86A90E" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>The Secretary shall,
subject to regulations the Secretary shall prescribe, provide for necessary
travel, lodging, and per diem expenses incurred by a family member of an
eligible veteran (or other individual designated by the veteran) in undergoing
training under this subsection.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id54894DCF134B4FF483ECABC1BDBB5596" indent="up1" reported-display-style="italic"><enum>(6)</enum><text>If the participation of a
family member of an eligible veteran (or other individual designated by the
veteran) in training under this subsection would interfere with the provision
of personal care services to the veteran, the Secretary shall, subject to
regulations as the Secretary shall prescribe and in consultation with the
veteran, provide respite care to the veteran during the provision of such
training to the family member so that such family caregiver (or designee) can
participate in such training without interfering with the provision of such
services.</text>
</paragraph></subsection><subsection id="idC78450F9948B47B4A29994307127B4B4"><enum>(e)</enum><header>Designation of primary
personal care attendant</header><paragraph commented="no" display-inline="yes-display-inline" id="idAF560CCEC1834B578BDB3A3971507FBC"><enum>(1)</enum><text>For each eligible
veteran with at least one family member (or other individual designated by the
veteran) who is described by subparagraphs (A) through (E) of paragraph (2),
the Secretary shall designate one family member of such veteran (or other
individual designated by the veteran) as the primary personal care attendant
for such veteran to be the primary provider of personal care services for such
veteran.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id396A2FC479B149C88AD6330987CB840A" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>A primary personal care
attendant designated for an eligible veteran under paragraph (1) shall be
selected from among family members of such veteran (or other individuals
designated by such veteran) who—</text>
<subparagraph id="id85D4EF3895CA45B2ACB972342D994FC6"><enum>(A)</enum><text>are approved under
subsection (d)(3) as a personal care attendant for such veteran;</text>
</subparagraph><subparagraph id="id79A1B189D518403A802B6E45EE098795"><enum>(B)</enum><text>complete all additional
instruction, preparation, and training, if any, provided under subsection
(d)(2);</text>
</subparagraph><subparagraph id="id1273F358609D465BBCD96D5D81A4446F"><enum>(C)</enum><text>elect to provide the
personal care services to such veteran that the Secretary determines such
veteran requires under subsection (c)(1);</text>
</subparagraph><subparagraph id="id37155518A0704F3FB3B6A2F41ABEF70B"><enum>(D)</enum><text>has the consent of such
veteran to be the primary provider of such services for such veteran;
and</text>
</subparagraph><subparagraph id="id868446E604BA49878FB7AC24D2EBB287"><enum>(E)</enum><text>the Secretary considers
competent to be the primary provider of such services for such veteran.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id6D57DBB7FBFD499EB47D39B679DC7F7C" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>An eligible veteran
receiving personal care services from a family member (or other individual
designated by the veteran) designated as the primary personal care attendant
for the veteran under paragraph (1) may revoke consent with respect to such
family member (or designee) under paragraph (2)(D) at any time.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idFD4275EE252542DAB8D348DC6B5ECB62" indent="up1" reported-display-style="italic"><enum>(4)</enum><text>If an individual
designated as the primary personal care attendant of an eligible veteran under
paragraph (1) subsequently fails to meet the requirements set forth in
paragraph (2), the Secretary—</text>
<subparagraph id="id00773374DB8249B785B1E6383E6C67F4"><enum>(A)</enum><text>shall immediately revoke
the individual's designation under paragraph (1); and</text>
</subparagraph><subparagraph id="id0A89D21B65C34A1CB11452FCECE1DA4D"><enum>(B)</enum><text>may designate, in
consultation with the eligible veteran or the eligible veteran's surrogate
appointed under subsection (g), a new primary personal care attendant for the
veteran under such paragraph.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id667003598A70443CADFF2D9CA8FB534A" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>The Secretary shall take
such actions as may be necessary to ensure that the revocation of a designation
under paragraph (1) does not interfere with the provision of personal care
services required by a veteran.</text>
</paragraph></subsection><subsection id="idD8DA15F144AB456DA83E6F953300D0AA"><enum>(f)</enum><header>Ongoing family
caregiver assistance</header><paragraph commented="no" display-inline="yes-display-inline" id="idC11A4D3E726B4C949D630F2F3FF9FFBE"><enum>(1)</enum><text>Except as provided in
subsection (a)(2) and subject to the provisions of this subsection, the
Secretary shall provide ongoing family caregiver assistance to family members
of eligible veterans (or other individuals designated by such veterans) as
follows:</text>
<subparagraph changed="added" committee-id="SSVA00" id="idE81A373EC2774F628B47A4B3E2216B64" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>To each family member of
an eligible veteran (or designee) who is approved under subsection (d)(3) as a
personal care attendant for the veteran the following:</text>
<clause id="id13EA4BC8C3404BD5A721FA114F3ADA6C"><enum>(i)</enum><text>Direct technical support
consisting of information and assistance to timely address routine, emergency,
and specialized caregiving needs.</text>
</clause><clause id="id82B3B64787824163900E810C979F7E6F"><enum>(ii)</enum><text>Counseling.</text>
</clause><clause id="id9C2870AA1FD4402E9766C4A10730BF8B"><enum>(iii)</enum><text>Access to an
interactive Internet website on caregiver services that addresses all aspects
of the provision of personal care services under this section.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id8E2A3D0A6CBD4223A106AD7B0BD5F2F9" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>To each family member of
an eligible veteran (or designee) who is designated as the primary personal
care attendant for the veteran under subsection (e) the following:</text>
<clause id="idFAB77AF294544DE49AAEF23777BC560C"><enum>(i)</enum><text>The ongoing family
caregiver assistance described in subparagraph (A).</text>
</clause><clause id="idF0F6965FC00A4D069A858FAA49B892A6"><enum>(ii)</enum><text>Mental health
services.</text>
</clause><clause id="idDA99B8E7FD864AB18F24350AFC1CE70B"><enum>(iii)</enum><text>Respite care of not
less than 30 days annually, including 24-hour per day care of the veteran
commensurate with the care provided by the family caregiver to permit extended
respite.</text>
</clause><clause id="idF4112A681DF94617A1FFE1600514F8BC"><enum>(iv)</enum><text>Medical care under
section 1781 of this title if such family member (or designee) is not entitled
to care or services under a health-plan contract (as defined in section 1725(f)
of this title).</text>
</clause><clause id="id0121B23989FF4EA2925D2C9B5AA6EE3C"><enum>(v)</enum><text>A monthly personal
caregiver stipend.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idF6F3A9DDC15D45DA9A253E185155C881" indent="up1" reported-display-style="italic"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idB638CB73DC7D40FF867D1CF87191CF8C"><enum>(A)</enum><text>The Secretary shall
provide respite care under paragraph (1)(B)(iii), at the election of the
Secretary—</text>
<clause changed="added" committee-id="SSVA00" id="id10B05CD9E9824B23839C0D407C240612" indent="up1" reported-display-style="italic"><enum>(i)</enum><text>through facilities of the
Department that are appropriate for the veteran; or</text>
</clause><clause changed="added" committee-id="SSVA00" id="id65011B1CC3D8498F83C9A2CFD7D07FD2" indent="up1" reported-display-style="italic"><enum>(ii)</enum><text>through contracts under
section 1720B(c) of this title.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id35A7B8A281E94F449E74FA1ADCBC6D3A" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>If the primary personal
care attendant of an eligible veteran designated under subsection (e)(1)
determines in consultation with the veteran or the veteran's surrogate
appointed under subsection (g), and the Secretary concurs, that the needs of
the veteran cannot be accommodated through the facilities and contracts
described in subparagraph (A), the Secretary shall, in consultation with the
primary personal care attendant and the veteran (or the veteran's surrogate),
provide respite care through other facilities or arrangements that are
medically and age appropriate.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idD0C83D93AFF44E388C5C92361A7ED808" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>If the Secretary
determines that the Department lacks the capacity to furnish medical care under
clause (iv) of paragraph (1)(B), the Secretary may contract, in accordance with
such regulations as the Secretary shall prescribe, for such insurance, medical
services, or health plans as the Secretary considers appropriate to furnish
such medical care.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id46AFB3DFFF9645D8B3E6F1126B7E6844" indent="up1" reported-display-style="italic"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idB8F56CBD257A45318F946D7E0619FF2D"><enum>(A)</enum><text>The Secretary shall
provide monthly personal caregiver stipends under paragraph (1)(B)(v) in
accordance with a schedule established by the Secretary that specifies stipends
provided based upon the amount and degree of personal care services
provided.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idB0328F398DF04147A7E425A1027C56B0" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>The Secretary shall
ensure, to the extent practicable, that the schedule required by subparagraph
(A) specifies that the amount of the personal caregiver stipend provided to a
primary personal care attendant designated under subsection (e)(1) for the
provision of personal care services to an eligible veteran is not less than the
amount a commercial home health care entity would pay an individual in the
geographic area of the veteran to provide equivalent personal care services to
the veteran.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id561B61AAC12340488E945183B173669D" indent="up1" reported-display-style="italic"><enum>(C)</enum><text>If personal care services
are not available from a commercial provider in the geographic area of an
eligible veteran, the Secretary may establish the schedule required by
subparagraph (A) with respect to the veteran by considering the costs of
commercial providers of personal care services in geographic areas other than
the geographic area of the veteran with similar costs of living.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id43D8985614984E96923244588CEFC569" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>Provision of ongoing
family caregiver assistance under this subsection for provision of personal
care services to an eligible veteran shall terminate if the veteran no longer
requires the personal care services.</text>
</paragraph></subsection><subsection id="id91A61B98B7C54A4AA91062F93FDFD0F3"><enum>(g)</enum><header>Surrogates</header><text>If
an eligible veteran lacks the capacity to submit an application, provide
consent, make a request, or concur with a request under this section, the
Secretary may, in accordance with regulations and policies of the Department
regarding the appointment of guardians or the use of powers of attorney,
appoint a surrogate for the veteran who may submit applications, provide
consent, make requests, or concur with requests on behalf of the veteran under
this section.</text>
</subsection><subsection id="id69E75AEF43564DDBA14EF09F6574198D"><enum>(h)</enum><header>Oversight</header><paragraph commented="no" display-inline="yes-display-inline" id="id07C318F6AEDE4664B9A9C9B77643A335"><enum>(1)</enum><text>The Secretary shall
enter into contracts with appropriate entities to provide oversight of the
provision of personal care services under this section by primary personal care
attendants designated under subsection (e)(1).</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idE7762489551E4115B91F5203020AE132" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall
ensure that each eligible veteran receiving personal care services under this
section from a primary personal care attendant designated under subsection
(e)(1) is visited in the veteran's home by an entity providing oversight under
paragraph (1) at such frequency as the Secretary shall determine under
paragraph (3).</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id0AEE2C7BCC754FEBB51E188E619BD6D9" indent="up1" reported-display-style="italic"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id0A42C43EB465446D8012D3E31A564EB6"><enum>(A)</enum><text>Except as provided in
subparagraph (B), the Secretary shall determine the manner of oversight
provided under paragraph (1) and the frequency of visits under paragraph (2)
for an eligible veteran as the Secretary considers commensurate with the needs
of such veteran.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="id5B4945B4BB9C4DFC97B6085F797C0F96" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>The frequency of visits
under paragraph (2) for an eligible veteran shall be not less frequent than
once every six months.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idB23BC6300B304135AE208A866E8536A8" indent="up1" reported-display-style="italic"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idD337B085790F491194341514FD3E3BC1"><enum>(A)</enum><text>An entity visiting an
eligible veteran under paragraph (2) shall submit to the Secretary the findings
of the entity with respect to each visit, including whether the veteran is
receiving the care the veteran requires.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idF3A5EBE698CD40239B476C5548A82679" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>If an entity finds under
subparagraph (A) that an eligible veteran is not receiving the care the veteran
requires, the entity shall submit to the Secretary a recommendation on the
corrective actions that should be taken to ensure that the veteran receives the
care the veteran requires, including, if the entity considers appropriate, a
recommendation for revocation of a caregiver's approval under subsection (d)(3)
or revocation of the designation of an individual under subsection
(e)(1).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="idD5295422780541A48B9C9BB68F5BC284" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>After receiving findings
and recommendations, if any, under paragraph (4) with respect to an eligible
veteran, the Secretary may take such actions as the Secretary considers
appropriate to ensure that the veteran receives the care the veteran requires,
including the following:</text>
<subparagraph id="idAD36B0C7D7304033B5397392562B2DF7"><enum>(A)</enum><text>Revocation of a
caregiver's approval under subsection (d)(3).</text>
</subparagraph><subparagraph id="idBEF1A175B2D34C2387B19FC32788713D"><enum>(B)</enum><text>Revocation of the
designation of an individual under subsection (e)(1).</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id5608B823119C40EB91B48067B02FB0EC" indent="up1" reported-display-style="italic"><enum>(6)</enum><text>If the Secretary
terminates the provision of ongoing family caregiver assistance under
subsection (f) to a family member of an eligible veteran (or other individual
designated by the veteran) because of findings of an entity submitted to the
Secretary under paragraph (4), the Secretary may not provide compensation to
such entity for the provision of personal care services to such veteran, unless
the Secretary determines it would be in the best interest of such veteran to
provide compensation to such entity to provide such services.</text>
</paragraph></subsection><subsection id="idDFCA801485DF403A92C4C8D59077B6FA"><enum>(i)</enum><header>Outreach</header><text>The
Secretary shall carry out a program of outreach to inform eligible veterans and
their family members of the availability and nature of family caregiver
assistance under this section.</text>
</subsection><subsection id="id60D035F00591449EA0C9F3BA3CD3E899"><enum>(j)</enum><header>Construction</header><paragraph commented="no" display-inline="yes-display-inline" id="idE3072A375B4E47E09ED257A40E9759A3"><enum>(1)</enum><text>A decision by the
Secretary under this section affecting the furnishing of family caregiver
assistance shall be considered a medical determination.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id8747FA837D0645B08A225888147CF956" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>Nothing in this section
shall be construed to create an employment relationship between the Secretary
and an individual in receipt of family caregiver assistance under this
section.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idAC721F501ACD4B35B800EF5972F58D55" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>Nothing in this section
shall be construed to create any entitlement to any services or stipends
provided under this section.</text>
</paragraph></subsection><subsection id="id85E4216DB4444C7F836AC7EBA3B16209"><enum>(k)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="id43403FE1F7E74DFFB99F1C9E0E3FD52D"><enum>(1)</enum><text>The term <term>family
caregiver assistance</term> includes the instruction, preparation, training,
and approval provided under subsection (d) and the ongoing family caregiver
assistance provided under subsection (f).</text>
</paragraph><paragraph id="id7E2E1ACD4E9E4EE7A05F335CD0DD87B0"><enum>(2)</enum><text>The term <term>family
member</term> shall have such meaning as the Secretary shall determine by
policy or regulation.</text>
</paragraph><paragraph id="id750780406E1D4BB3BAC2381224A082A3"><enum>(3)</enum><text>The term <term>personal
care services</term>, with respect to a veteran, includes the following:</text>
<subparagraph id="idB30DE6A942AB4FA8B7819C0E228768A1"><enum>(A)</enum><text>Supervision of the
veteran.</text>
</subparagraph><subparagraph id="id687BADA93C1F474EB794612D94A50CC8"><enum>(B)</enum><text>Protection of the
veteran.</text>
</subparagraph><subparagraph id="idA9F538724FEC4909840BE148260F747F"><enum>(C)</enum><text>Services to assist the
veteran with one or more independent activities of daily living.</text>
</subparagraph><subparagraph id="idC1085BE5D9C74A849C1E42B8DED69D9C"><enum>(D)</enum><text>Such other services as
the Secretary considers
appropriate.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="idFEC224A0920444739C34850898E6349E"><enum>(2)</enum><header>Clerical
amendment</header><text>The table of sections at the beginning of chapter 17 is
amended by inserting after the item related to section 1717 the following new
item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idBA9F7A44A27143409C08CC53B98A1D77" reported-display-style="italic" style="OLC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">1717A. Family caregiver
assistance.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="idDE8573ADBBD74834A25F7F2EDAF0A1B3"><enum>(3)</enum><header>Authorization for
provision of health care to personal care attendants</header><text>Section
1781(a) is amended—</text>
<subparagraph id="id093D7FB55A5E4C2EA6C0FDFA78BEF496"><enum>(A)</enum><text>by redesignating
paragraphs (2) and (3) as paragraphs (3) and (4), respectively; and</text>
</subparagraph><subparagraph id="idB31FF7B61C964F5B91166AB49F606F6A"><enum>(B)</enum><text>by inserting after
paragraph (1) the following new paragraph (2):</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idE9C07AF464EE4AF0A79FFFC89B5B12E0" reported-display-style="italic" style="OLC">
<paragraph id="id507E2209316C465F8977A3DD8E07FC89"><enum>(2)</enum><text>a family member of a
veteran (or other individual designated by the veteran) designated as the
primary personal care attendant for such veteran under section 1717A(e) of this
title who is not entitled to care or services under a health-plan contract (as
defined in section 1725(f) of this
title),</text>
</paragraph><after-quoted-block>.
</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id491E7B42097D4966B641038C5DAECC58"><enum>(4)</enum><header>Construction</header><text>Any
family caregiver assistance furnished under section 1717A of title 38, United
States Code, as added by paragraph (1), is in addition to any family caregiver
assistance furnished under other programs of the Department of Veterans Affairs
as of the date of the enactment of this Act.</text>
</paragraph><paragraph id="id66CCDFB83BFB4B639FEAEEEA50942F79"><enum>(5)</enum><header>Effective
date</header><text>The amendments made by this subsection shall take effect on
the date that is 270 days after the date of the enactment of this Act.</text>
</paragraph></subsection><subsection id="id7C602EEF8AF846FAB42CB17385FF8C6B"><enum>(b)</enum><header>Implementation plan and
report</header>
<paragraph id="id65121E969BBE4105A818F79D429A67F1"><enum>(1)</enum><header>In
general</header><text>Not later than 180 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall—</text>
<subparagraph id="idD7EA9812182C42D080E90D008A5F059D"><enum>(A)</enum><text>develop a plan for the
implementation of section 1717A of title 38, United States Code, as added by
subsection (a)(1); and</text>
</subparagraph><subparagraph id="id45F01A3863E84B1A9D9A23D2BD963059"><enum>(B)</enum><text>submit to the Committee
on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of
the House of Representatives a report on such plan.</text>
</subparagraph></paragraph><paragraph id="id2D75BEE8D17242B785D7DAFCC4322B74"><enum>(2)</enum><header>Consultation</header><text>In
developing the plan required by paragraph (1)(A), the Secretary shall consult
with the following:</text>
<subparagraph id="id70FFAB808BDC42D180C72195A2A45E46"><enum>(A)</enum><text>Veterans described in
section 1717A(b) of title 38, United States Code, as added by subsection
(a)(1).</text>
</subparagraph><subparagraph commented="no" id="idBFF5BF19CB574C56A1ED226F25367202"><enum>(B)</enum><text>Family members of
veterans who provide personal care services to such veterans.</text>
</subparagraph><subparagraph id="idEC59DFE6956349B2BB25A2BD0D0CCF1D"><enum>(C)</enum><text>Veterans service
organizations, as recognized by the Secretary of Veterans Affairs for the
representation of veterans under section 5902 of title 38, United States
Code.</text>
</subparagraph><subparagraph id="id8B15B6DC5E544179A12ABE3DE196F781"><enum>(D)</enum><text>National organizations
that specialize in the provision of assistance to individuals with the types of
disabilities that personal care attendants will encounter while providing
personal care services under section 1717A of title 38, United States Code, as
so added.</text>
</subparagraph><subparagraph id="id479A314ECD69400ABF661CDE5A52948C"><enum>(E)</enum><text>Such other organizations
with an interest in the provision of care to veterans as the Secretary
considers appropriate.</text>
</subparagraph><subparagraph id="id064078F3C710492A9EB6AF7DAFD535BD"><enum>(F)</enum><text>The Secretary of Defense
with respect to matters concerning personal care services for members of the
Armed Forces undergoing medical discharge from the Armed Forces who are
eligible to benefit from family caregiver assistance furnished under section
1717A of title 38, United States Code, as so added.</text>
</subparagraph></paragraph><paragraph id="id7D190D555A934EDFBAE13FB5F1089AE3"><enum>(3)</enum><header>Report
contents</header><text>The report required by paragraph (1)(B) shall contain
the following:</text>
<subparagraph id="id1E1835F5E7A24D088AC88E9B22363676"><enum>(A)</enum><text>The plan required by
paragraph (1)(A).</text>
</subparagraph><subparagraph id="id06014A81C97544C5A2EFB9EC6F15705A"><enum>(B)</enum><text>A description of the
veterans, caregivers, and organizations consulted by the Secretary under
paragraph (2).</text>
</subparagraph><subparagraph id="idAC649DB5DAF3492B94803D873D0FFFAB"><enum>(C)</enum><text>A description of such
consultations.</text>
</subparagraph><subparagraph id="idDD845BFB2A1D426D811A60883C019697"><enum>(D)</enum><text>The recommendations of
such veterans, caregivers, and organizations, if any, that were not
incorporated into the plan required by paragraph (1)(A).</text>
</subparagraph><subparagraph id="idC69D88263E374CE392FF5A0FE4E722A9"><enum>(E)</enum><text>The reasons the Secretary
did not incorporate such recommendations into such plan.</text>
</subparagraph></paragraph></subsection><subsection id="idEA4163BA21114EAEBCB84AD657139EF3"><enum>(c)</enum><header>Annual evaluation
report</header>
<paragraph id="idD5F71E1257F14AF680D9DDFC982021DF"><enum>(1)</enum><header>In
general</header><text>Not later than two years after the date described in
subsection (a)(5) and annually thereafter, the Secretary shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives a comprehensive report on the
implementation of section 1717A of title 38, United States Code, as added by
subsection (a)(1).</text>
</paragraph><paragraph id="idF3B320A4EF2E4CA1A90703BAB9C8BA90"><enum>(2)</enum><header>Contents</header><text>The
report required by paragraph (1) shall include the following:</text>
<subparagraph id="idD52F8C495652489B80C94C8168E4BACF"><enum>(A)</enum><text>The number of family
members (or other designated individuals) of veterans or members of the Armed
Forces that received family caregiver assistance under such section
1717A.</text>
</subparagraph><subparagraph id="idAF052988691E46D988F95EC6A4952C20"><enum>(B)</enum><text>A description of the
outreach activities carried out by the Secretary in accordance with subsection
(i) of such section 1717A.</text>
</subparagraph><subparagraph id="id6E6F2F9936B442EAAEBA99385ADACD26"><enum>(C)</enum><text>The resources expended by
the Secretary under such section 1717A.</text>
</subparagraph><subparagraph id="idC079FC5351F74161A523F4EC6C5D0E91"><enum>(D)</enum><text>An assessment of the
manner in which resources are expended by the Secretary under such section
1717A, particularly with respect to the provision of monthly personal caregiver
stipends under subsection (f) of such section.</text>
</subparagraph><subparagraph id="idA02A86436C9E4478B47D894E3B616D12"><enum>(E)</enum><text>A description of the
outcomes achieved by, and any measurable benefits of, carrying out the
requirements of such section 1717A.</text>
</subparagraph><subparagraph id="idA90AB890828E4367A0425596725826FA"><enum>(F)</enum><text>A justification of any
determination made under subsection (b)(2) of such section 1717A.</text>
</subparagraph><subparagraph id="id4279ED63099343AEACD9876F6395B82F"><enum>(G)</enum><text>An assessment of the
effectiveness and the efficiency of the implementation of such section
1717A.</text>
</subparagraph><subparagraph id="id70068C3EF3994264B28DC061EC0ABBBC"><enum>(H)</enum><text>An assessment of how the
provision of family caregiver assistance fits into the continuum of home health
care services and benefits provided to veterans in need of such services and
benefits.</text>
</subparagraph><subparagraph id="id3B36CF2F8A5642A4B3B1003E2D84ED1A"><enum>(I)</enum><text>Such recommendations,
including recommendations for legislative or administrative action, as the
Secretary considers appropriate in light of carrying out the requirements of
such section 1717A.</text>
</subparagraph></paragraph></subsection></section><section id="id9FD9BB3351F44E3482366B7B5FF24925"><enum>103.</enum><header>Lodging and
subsistence for attendants</header><text display-inline="no-display-inline">Section 111(e) is amended—</text>
<paragraph id="idCBE9625D4BD247A2BB8410860700E88E"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>When any</quote> and
inserting <quote>(1) When any</quote>;</text>
</paragraph><paragraph id="idCC3D974ABCB84C13A13BDC1E469A8F46"><enum>(2)</enum><text>in paragraph (1), as
designated by paragraph (1) of this subsection—</text>
<subparagraph id="idBF933F21495D43FC87F34BA0B19D8DC6"><enum>(A)</enum><text>by inserting
<quote>(including lodging and subsistence)</quote> after <quote>expenses of
travel</quote>; and</text>
</subparagraph><subparagraph id="id279EA219CF2F4D64AD681F92AD3C5010"><enum>(B)</enum><text>by inserting before the
period at the end the following: <quote>for the period consisting of travel to
and from a treatment facility and the duration of the treatment episode at that
facility</quote>; and</text>
</subparagraph></paragraph><paragraph id="id6ECE6E3A2E0642DCBE46C5F28074DA6D"><enum>(3)</enum><text>by adding at the end the
following:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idBF2D1C13ADC047DCABD361E8870736E3" reported-display-style="italic" style="OLC">
<paragraph id="id5E216D0F854B468BBE18CAFE6E8C740B" indent="up1"><enum>(2)</enum><text>The Secretary may
prescribe regulations to carry out this subsection. Such regulations may
include provisions—</text>
<subparagraph id="id771EBD51526E4A758DFF7DA3DADB0580"><enum>(A)</enum><text>to limit the number of
individuals that may receive expenses of travel under paragraph (1) for a
single treatment episode of a person; and</text>
</subparagraph><subparagraph id="idFD29304C9945424984685B5C2F5C1383"><enum>(B)</enum><text>to require attendants to
use certain travel services.</text>
</subparagraph></paragraph><paragraph id="idA89159D5A9E44A9CA223B9C020BB5A7A" indent="up1"><enum>(3)</enum><text>In this
subsection:</text>
<subparagraph id="id5F2B5B51422848E89F26D5D8F3B0343B"><enum>(A)</enum><text>The term
<term>attendant</term> includes, with respect to a person described in
paragraph (1), the following:</text>
<clause id="idF79C0783BABC474BB497201856A249F6"><enum>(i)</enum><text>A family member of the
person.</text>
</clause><clause id="id80180D95B9704442A2C8A419864EA280"><enum>(ii)</enum><text>An individual approved
as a personal care attendant under section 1717A(d)(3) of this title.</text>
</clause><clause id="idA5DC788B6AEF42F594DEEF42B9FBD6C3"><enum>(iii)</enum><text>Any other individual
whom the Secretary determines—</text>
<subclause id="id61001D59CD314369B05A19D5253E0AF7"><enum>(I)</enum><text>has a preexisting
relationship with the person; and</text>
</subclause><subclause id="id4786DE8E61DF492AB162D5474545E1DA"><enum>(II)</enum><text>provides a significant
portion of the person's care.</text>
</subclause></clause></subparagraph><subparagraph id="id5C1E81F9BC584D0292343ED2E723DFA7"><enum>(B)</enum><text>The term <term>family
member</term> shall have such meaning as the Secretary shall determine by
policy or
regulation.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="ID2bbbd412579b44a8bb34af7cc3edd267"><enum>104.</enum><header>Survey of informal
caregivers</header>
<subsection id="id13F88CDAF42B48ACA83B5CA1FD4FA87F"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">The Secretary of
Veterans Affairs shall, in collaboration with the Secretary of Defense, conduct
a national survey of family caregivers of seriously disabled veterans and
members of the Armed Forces to better understand the size and characteristics
of the population of such caregivers and the types of care they provide such
veterans and members.</text>
</subsection><subsection id="id304B2B95DF414650BAB60A845212CC97"><enum>(b)</enum><header>Report</header><text>Not
later than 540 days after the date of the enactment of this Act, the Secretary
of Veterans Affairs shall, in collaboration with the Secretary of Defense,
submit to Congress a report containing the findings of the Secretary with
respect to the survey conducted under subsection (a). Results of the survey
shall be disaggregated by the following:</text>
<paragraph id="id8B29EA085F4C462EB51E072ACE7E2BE5"><enum>(1)</enum><text>Veterans and members of
the Armed Forces.</text>
</paragraph><paragraph id="idC1DFC421FD434ACF84A2E758F5A4A851"><enum>(2)</enum><text>Veterans and members of
the Armed Forces who served in Operation Iraqi Freedom or Operation Enduring
Freedom.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idDAD779C7E802412A997DFA15E4066F53"><enum>(3)</enum><text>Veterans and members of
the Armed Forces who live in rural areas.</text>
</paragraph></subsection></section><enum>II</enum><header>Rural health
improvements</header>
<section id="id94E2FE48B9844C4EB3576356A241940E"><enum>201.</enum><header>Enhancement of
Department of Veterans Affairs Education Debt Reduction Program</header>
<subsection id="idCF951E4B4A604218BEAA2F0DD83A3350"><enum>(a)</enum><header>Enhanced maximum annual
amount</header><text>Paragraph (1) of section 7683(d) is amended by striking
<quote>$44,000</quote> and all that follows through <quote>fifth years of
participation in the Program</quote> and inserting <quote>the total amount of
principle and interest owed by the participant on loans referred to in
subsection (a)</quote>.</text>
</subsection><subsection id="id645F1811E6BD4890B860B33A2C4C1E7E"><enum>(b)</enum><header>Notice to potential
employees of eligibility and selection for participation</header><text>Section
7682 is amended by adding at the end the following new subsection:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id47C31B489DB045E7ABC869D5B4B7CF3D" reported-display-style="italic" style="USC">
<subsection id="idE7677F3980DA417EAC098F0D29DFD33A"><enum>(d)</enum><header>Notice to potential
employees</header><text>In each offer of employment made by the Secretary to an
individual who, upon acceptance of such offer would be treated as eligible to
participate in the Education Debt Reduction Program, the Secretary shall, to
the maximum extent practicable, include the following:</text>
<paragraph id="idFC6BA34A59B243C4B42CA61C18508B65"><enum>(1)</enum><text>A notice that the
individual will be treated as eligible to participate in the Education Debt
Reduction Program upon the individual's acceptance of such offer.</text>
</paragraph><paragraph id="id34028BD6B5504CB1BEA36C51267D3CAB"><enum>(2)</enum><text>A notice of the
determination of the Secretary whether or not the individual will be selected
as a participant in the Education Debt Reduction Program as of the individual's
acceptance of such
offer.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id5D72591EDEB34C67830DC3A37B8E1435"><enum>(c)</enum><header>Selection of employees
who receive notice of selection with employment offer</header><text>Section
7683 is further amended by adding at the end the following new
subsection:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idCF34DAA2E89643D9B7E4DF684305CA24" reported-display-style="italic" style="USC">
<subsection id="id73CF2828A11E47F28CE9813B4360A12D"><enum>(e)</enum><header>Selection of
participants</header><paragraph commented="no" display-inline="yes-display-inline" id="id928F0F9B4A2444EB9C37F87EC11A6260"><enum>(1)</enum><text>The Secretary shall
select for participation in the Education Debt Reduction Program each
individual eligible for participation in the Education Debt Reduction Program
who—</text>
<subparagraph changed="added" committee-id="SSVA00" id="idD7F7EFF484BB4E748CC093929D288EC2" indent="up1" reported-display-style="italic"><enum>(A)</enum><text>the Secretary provided
notice with an offer of employment under section 7682(d) of this title that
indicated the individual would, upon the individual's acceptance of such offer
of employment, be—</text>
<clause id="id50323AA2E2024469BCA315E47C0BC886"><enum>(i)</enum><text>eligible to participate
in the Education Debt Reduction Program; and</text>
</clause><clause id="id0C25E25A9A89432F8373BD20CDDD1DDB"><enum>(ii)</enum><text>selected to participate
in the Education Debt Reduction Program; and</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idECACB569FCAF4DFC9E84475D3333945C" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>accepts such offer of
employment.</text>
</subparagraph></paragraph><paragraph changed="added" commented="no" committee-id="SSVA00" display-inline="no-display-inline" id="idA329C7F5FA8D448BA39C5F5AEDC148CC" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The
Secretary may select for participation in the Education Debt Reduction Program
an individual eligible for participation in the Education Debt Reduction
Program who is not described by subparagraphs (A) and (B) of paragraph
(1).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idB808AECD923C4B73B464CEB42BFAE6F4" section-type="subsequent-section"><enum>202.</enum><header>Visual impairment
and orientation and mobility professionals education assistance
program</header>
<subsection id="id116AC0E5A3E240C5B05C37BD44755AA1"><enum>(a)</enum><header>Establishment of
program</header><text display-inline="yes-display-inline">Part V is amended by
inserting after chapter 74 the following new chapter:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id5F75265EA0FF4652B25E93423DF3BDD1" reported-display-style="italic" style="USC">
<chapter id="id448BD301BE494E3FB67B791FA77FA9AA"><enum>75</enum><header>Visual Impairment and
Orientation and Mobility Professionals Education Assistance Program</header>
<toc regeneration="no-regeneration">
<toc-entry level="section">Sec.</toc-entry>
<toc-entry level="section">7501. Establishment of scholarship program;
purpose.</toc-entry>
<toc-entry level="section">7502. Application and acceptance.</toc-entry>
<toc-entry level="section">7503. Amount of assistance;
duration.</toc-entry>
<toc-entry level="section">7504. Agreement.</toc-entry>
<toc-entry level="section">7505. Repayment for failure to satisfy
requirements of agreement.</toc-entry>
</toc>
<section id="id11F01F9D30F74D159F84A80DF6BBAB7D"><enum>7501.</enum><header>Establishment of
scholarship program; purpose</header>
<subsection id="idA528FAB725B1400F8DA19D4A39D2B3B9"><enum>(a)</enum><header>Establishment</header><text>Subject
to the availability of appropriations, the Secretary shall establish and carry
out a scholarship program to provide financial assistance in accordance with
this chapter to an individual—</text>
<paragraph id="id2D2B0B3D329F4014BB0A3F55192CD3B9"><enum>(1)</enum><text>who is accepted for
enrollment or currently enrolled in a program of study leading to a degree or
certificate in visual impairment or orientation and mobility, or a dual degree
or certification in both such areas, at an accredited (as determined by the
Secretary) educational institution that is in a State; and</text>
</paragraph><paragraph id="id2E355C54A02A4224A3679F278412ACAE"><enum>(2)</enum><text>who enters into an
agreement with the Secretary as described in section 7504 of this
chapter.</text>
</paragraph></subsection><subsection id="idEBC10520780A40DF8F7EBEC569FE059B"><enum>(b)</enum><header>Purpose</header><text>The
purpose of the scholarship program established under this chapter is to
increase the supply of qualified blind rehabilitation specialists for the
Department and the Nation.</text>
</subsection><subsection id="id619076E35B58461E9CA4501B5621572E"><enum>(c)</enum><header>Outreach</header><text>The
Secretary shall publicize the scholarship program established under this
chapter to educational institutions throughout the United States, with an
emphasis on disseminating information to such institutions with high numbers of
Hispanic students and to Historically Black Colleges and Universities.</text>
</subsection></section><section id="idC77A88A9DAF9432E96F8A895006FDC4C"><enum>7502.</enum><header>Application and
acceptance</header>
<subsection id="id0E35C286B68D4CD6A270BD09619CDFCE"><enum>(a)</enum><header>Application</header><paragraph commented="no" display-inline="yes-display-inline" id="id6A89CCB8E12C419E991893A83DE35504"><enum>(1)</enum><text>To apply and
participate in the scholarship program under this chapter, an individual shall
submit to the Secretary an application for such participation together with an
agreement described in section 7504 of this chapter under which the participant
agrees to serve a period of obligated service in the Department as provided in
the agreement in return for payment of educational assistance as provided in
the agreement.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id09CF45451C2445FC8D7420BFA83A9E0D" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>In distributing
application forms and agreement forms to individuals desiring to participate in
the scholarship program, the Secretary shall include with such forms the
following:</text>
<subparagraph id="id25F3F4DE027C42A186F1CBB38C99F6E9"><enum>(A)</enum><text>A fair summary of the
rights and liabilities of an individual whose application is approved (and
whose agreement is accepted) by the Secretary.</text>
</subparagraph><subparagraph id="id8D1BF5EFEFFF4DE5A0551DCB22FE1825"><enum>(B)</enum><text>A full description of the
terms and conditions that apply to participation in the scholarship program and
service in the Department.</text>
</subparagraph></paragraph></subsection><subsection id="idA8B8145E51664E72AE88549B65C87437"><enum>(b)</enum><header>Approval</header><paragraph commented="no" display-inline="yes-display-inline" id="id2E7F10C5BD7E4127815E6F1919E08D7D"><enum>(1)</enum><text>Upon the Secretary’s
approval of an individual’s participation in the scholarship program, the
Secretary shall, in writing, promptly notify the individual of that
acceptance.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id6DA23FB41434419D93F43321F61E06B9" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>An individual becomes a
participant in the scholarship program upon such approval by the
Secretary.</text>
</paragraph></subsection></section><section id="id4DCA457F851C4BF098E581FEB2AB0BD3"><enum>7503.</enum><header>Amount of assistance;
duration</header>
<subsection id="id25B0F5C876244DCFB577B178972E3BEC"><enum>(a)</enum><header>Amount of
assistance</header><text>The amount of the financial assistance provided for an
individual under this chapter shall be the amount determined by the Secretary
as being necessary to pay the tuition and fees of the individual. In the case
of an individual enrolled in a program of study leading to a dual degree or
certification in both the areas of study described in section 7501(a)(1) of
this chapter, the tuition and fees shall not exceed the amounts necessary for
the minimum number of credit hours to achieve such dual certification or
degree.</text>
</subsection><subsection commented="no" id="idA75EDB62F7104D03AF28E7A7CB0E1BBD"><enum>(b)</enum><header>Relationship to other
assistance</header><text>Financial assistance may be provided to an individual
under this chapter to supplement other educational assistance to the extent
that the total amount of educational assistance received by the individual
during an academic year does not exceed the total tuition and fees for such
academic year.</text>
</subsection><subsection commented="no" id="id1A36B199536143EA9EEFCBD21D82B031"><enum>(c)</enum><header>Maximum amount of
assistance</header><paragraph commented="no" display-inline="yes-display-inline" id="idC9FE801E41E648318F1B3E97740CE0DC"><enum>(1)</enum><text>In no case may the
total amount of assistance provided under this chapter for an academic year to
an individual who is a full-time student exceed $15,000.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id093C8FCB7E684FECA17AB3D63377FE9F" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>In the case of an
individual who is a part-time student, the total amount of assistance provided
under this chapter shall bear the same ratio to the amount that would be paid
under paragraph (1) if the participant were a full-time student in the program
of study being pursued by the individual as the coursework carried by the
individual to full-time coursework in that program of study.</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSVA00" id="id09D0E290AF6D4152BC181D43EA1840F0" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>In no case may the total
amount of assistance provided to an individual under this chapter exceed
$45,000.</text>
</paragraph></subsection><subsection commented="no" id="idAE375016F3F142A58930D0499DE090AA"><enum>(d)</enum><header>Maximum duration of
assistance</header><text>The Secretary may provide financial assistance to an
individual under this chapter for not more than six years.</text>
</subsection></section><section id="idFEA2BED5F76C4A09BE4FE20C2F85D80E"><enum>7504.</enum><header>Agreement</header><text display-inline="no-display-inline">An agreement between the Secretary and a
participant in the scholarship program under this chapter shall be in writing,
shall be signed by the participant, and shall include—</text>
<paragraph id="id38A17AEDC8D247A8AE226FEA8844D3EC"><enum>(1)</enum><text>the Secretary’s agreement
to provide the participant with financial assistance as authorized under this
chapter;</text>
</paragraph><paragraph id="id68790FCB4A0145BEAC08C7C4B87BFEC6"><enum>(2)</enum><text>the participant’s
agreement—</text>
<subparagraph id="id99B8ADE0523346D2B2F58BDEF2DB24B3"><enum>(A)</enum><text>to accept such financial
assistance;</text>
</subparagraph><subparagraph id="idE88D74C1D8A24183A917F3AD45C5D488"><enum>(B)</enum><text>to maintain enrollment
and attendance in the program of study described in section 7501(a)(1) of this
chapter;</text>
</subparagraph><subparagraph id="id1D03744BE8E34B3DB1A83F2F78C5771D"><enum>(C)</enum><text>while enrolled in such
program, to maintain an acceptable level of academic standing (as determined by
the educational institution offering such program under regulations prescribed
by the Secretary); and</text>
</subparagraph><subparagraph id="id8894E3677C8945E8A05A3DEF9AC9DED9"><enum>(D)</enum><text>after completion of the
program, to serve as a full-time employee in the Department for a period of
three years, to be served within the first six years after the participant has
completed such program and received a degree or certificate described in
section 7501(a)(1) of this chapter; and</text>
</subparagraph></paragraph><paragraph id="id6ECC9B280ABE4F469C58D6FEA0A8EE15"><enum>(3)</enum><text>any other terms and
conditions that the Secretary determines appropriate for carrying out this
chapter.</text>
</paragraph></section><section commented="no" id="idA1BD421139F74055BEE8FCF93BD28EFB"><enum>7505.</enum><header>Repayment for failure
to satisfy requirements of agreement</header>
<subsection commented="no" id="id5FCD1F107A0C4EED9E34FC67C2CD88C1"><enum>(a)</enum><header>In
general</header><text>An individual who receives educational assistance under
this chapter shall repay to the Secretary an amount equal to the unearned
portion of such assistance if the individual fails to satisfy the requirements
of the agreement entered into under section 7504 of this chapter, except in
circumstances authorized by the Secretary.</text>
</subsection><subsection commented="no" id="idB4E573FED6D341C1A80D2E7426D5FFE0"><enum>(b)</enum><header>Amount of
repayment</header><text>The Secretary shall establish, by regulations,
procedures for determining the amount of the repayment required under this
subsection and the circumstances under which an exception to the required
repayment may be granted.</text>
</subsection><subsection commented="no" id="idCA8E71F89E094D6E9E8F9CB07F39BBA5"><enum>(c)</enum><header>Waiver or suspension of
compliance</header><text>The Secretary shall prescribe regulations providing
for the waiver or suspension of any obligation of an individual for service or
payment under this chapter (or an agreement under this chapter) whenever
noncompliance by the individual is due to circumstances beyond the control of
the individual or whenever the Secretary determines that the waiver or
suspension of compliance is in the best interest of the United States.</text>
</subsection><subsection commented="no" id="idEE31C3EFB1C342789F9824432C4C1553"><enum>(d)</enum><header>Obligation as debt to
United States</header><text>An obligation to repay the Secretary under this
section is, for all purposes, a debt owed the United States. A discharge in
bankruptcy under title 11 does not discharge a person from such debt if the
discharge order is entered less than five years after the date of the
termination of the agreement or contract on which the debt is
based.</text>
</subsection></section></chapter><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id251ACF64E4DE40D2AC47C966B510C897"><enum>(b)</enum><header>Clerical
amendments</header><text display-inline="yes-display-inline">The tables of
chapters at the beginning of title 38, and of part V of title 38, are each
amended by inserting after the item relating to chapter 74 the following new
item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idC7316390FEB34FBEB1C70B5E7B0FCEAD" reported-display-style="italic" style="USC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<multi-column-toc-entry bold="off" level="section"><toc-enum>75.</toc-enum><level-header level="section">Visual Impairment and Orientation and Mobility Professionals
Education Assistance
Program</level-header><target>7501.</target></multi-column-toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idA084EB67B04F45DAB89A5C0A32FD7C40"><enum>(c)</enum><header>Effective
date</header><text display-inline="yes-display-inline">The Secretary of
Veterans Affairs shall implement chapter 75 of title 38, United States Code, as
added by subsection (a), not later than six months after the date of the
enactment of this Act.</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="id760DF6E6D2BF4828A4BF3756DA536FC8" section-type="subsequent-section"><enum>203.</enum><header display-inline="yes-display-inline">Inclusion of Department of Veterans Affairs
facilities in list of facilities eligible for assignment of participants in
National Health Service Corps Scholarship Program</header><text display-inline="no-display-inline">The Secretary of Veterans Affairs shall
transfer $20,000,000 from accounts of the Veterans Health Administration to the
Secretary of Health and Human Services to include facilities of the Department
of Veterans Affairs in the list maintained by the Health Resources and Services
Administration of facilities eligible for assignment of participants in the
National Health Service Corps Scholarship Program.</text>
</section><section id="id5E04E88834FF4A11A985E2AD1A2DB44D"><enum>204.</enum><header>Teleconsultation and
telemedicine</header>
<subsection id="id69BD644D0F0F45F98E362C64D874B542"><enum>(a)</enum><header>Teleconsultation and
teleretinal imaging</header>
<paragraph id="idC2F91DF3081F4DC0B263F2CEA3508C57"><enum>(1)</enum><header>In
general</header><text>Subchapter I of chapter 17 is amended by adding at the
end the following new section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idD6FB79C2E5A0444B922987E7318401E5" reported-display-style="italic" style="USC">
<section id="idA028FC9242EF4530942020EC424FBFEA"><enum>1709.</enum><header>Teleconsultation and
teleretinal imaging</header>
<subsection id="ID7df09665763742e6b46aeb9997c072df"><enum>(a)</enum><header>Teleconsultation</header><paragraph commented="no" display-inline="yes-display-inline" id="idA808DA86092D4D79A31C4C5F49BD0764"><enum>(1)</enum><text>The Secretary shall
carry out a program of teleconsultation for the provision of remote mental
health and traumatic brain injury assessments in facilities of the Department
that are not otherwise able to provide such assessments without contracting
with third party providers or reimbursing providers through a fee-basis
system.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id2CAC29A3931D460BB753A1CBA83B5749" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall, in
consultation with appropriate professional societies, promulgate technical and
clinical care standards for the use of teleconsultation services within
facilities of the Department.</text>
</paragraph></subsection><subsection id="ID760ca0713d884282aabedc0a36108daa"><enum>(b)</enum><header>Teleretinal
imaging</header><text>The Secretary shall carry out a program of teleretinal
imaging in each Veterans Integrated Services Network (VISN).</text>
</subsection><subsection id="idE3229E66BEA34E949BE6F0ABFCE31860"><enum>(c)</enum><header>Annual
reports</header><text>In each fiscal year beginning with fiscal year 2010 and
ending with fiscal year 2015, the Secretary shall submit to Congress a report
on the programs required by subsections (a) and (b). Such report shall include
the following:</text>
<paragraph id="idC1E45803C83D487792742A0E3C328C75"><enum>(1)</enum><text>A description of the
efforts made by the Secretary to make teleconsultation available in rural areas
and to utilize teleconsultation in rural areas.</text>
</paragraph><paragraph id="id212AC7217FDD406A893F7538EF2971E1"><enum>(2)</enum><text>The rates of utilization
of teleconsultation by Veterans Integrated Services Network disaggregated by
each fiscal year for which a report is submitted under this subsection.</text>
</paragraph></subsection><subsection id="ID486b354ad0f84a5197f5f917cf2b5ebe"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="ID791757aa9c3b4f9780e755e52166c3a4"><enum>(1)</enum><text>The term
<term>teleconsultation</term> means the use by a health care specialist of
telecommunications to assist another health care provider in rendering a
diagnosis or treatment.</text>
</paragraph><paragraph id="id5BCE0D66232B4987BCFBCF2B3E8883BC"><enum>(2)</enum><text>The term
<term>teleretinal imaging</term> means the use by a health care specialist of
telecommunications, digital retinal imaging, and remote image interpretation to
provide eye
care.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="idFC412581F73F4D728C784F6E4761BFCA"><enum>(2)</enum><header>Clerical
amendment</header><text>The table of sections at the beginning of chapter 17 is
amended by inserting after the item related to section 1708 the following new
item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id3FE855AF50534CB38098605D0EC36E0C" reported-display-style="italic" style="USC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">1709. Teleconsultation and
teleretinal
imaging.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="ID966b5cc5f5fd4b9086f94f554a4ccf57"><enum>(b)</enum><header>Training in
telemedicine</header><text>The Secretary of Veterans Affairs shall require each
Department of Veterans Affairs facility that is involved in the training of
medical residents to work with each university concerned to develop an elective
rotation in telemedicine for such residents.</text>
</subsection><subsection id="idE42E14F7A2E3447DA8A64FA9E67C5BFF"><enum>(c)</enum><header>Enhancement of
VERA</header>
<paragraph id="ID6109635ef5dd486cb3587f8a46e0004a"><enum>(1)</enum><header>Incentives for
provision of teleconsultation, teleretinal imaging, telemedicine, and
telehealth services</header><text>The Secretary of Veterans Affairs shall
modify the Veterans Equitable Resource Allocation system to provide Veterans
Integrated Services Networks with incentives to utilize teleconsultation,
teleretinal imaging, telemedicine, and telehealth coordination services.</text>
</paragraph><paragraph id="id9E14BB986BCD4BC294DA21A531FCC025"><enum>(2)</enum><header>Inclusion of
telemedicine visits in workload reporting</header><text>The Secretary shall
modify the Veterans Equitable Resource Allocation system to require the
inclusion of all telemedicine visits in the calculation of facility
workload.</text>
</paragraph></subsection><subsection id="id862C61135EB844AB9B9329E958D29264"><enum>(d)</enum><header>Definitions</header><text>In
this section:</text>
<paragraph id="id21B182BC277743B2ACAADD9422386821"><enum>(1)</enum><text>The terms
<term>teleconsultation</term> and <term>teleretinal imaging</term> have the
meanings given such terms in section 1709 of title 38, United States Code, as
added by subsection (a).</text>
</paragraph><paragraph id="IDd1f88d7c4aa34c628207c37e70a4671a"><enum>(2)</enum><text>The term
<term>telemedicine</term> means the use by a health care provider of
telecommunications to assist in the diagnosis or treatment of a patient's
medical condition.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="IDdfe9cae7c2e24965b26c2c1c128b5ad3"><enum>(3)</enum><text>The term
<term>telehealth</term> means the use of telecommunications to collect patient
data remotely and send data to a monitoring station for interpretation.</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="IDbb08255b3028444780edceb370ca994e" section-type="subsequent-section"><enum>205.</enum><header display-inline="yes-display-inline">Demonstration projects on alternatives for
expanding care for veterans in rural areas</header>
<subsection commented="no" display-inline="no-display-inline" id="IDf68ef0753d7446028290ed5e820287a2"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs, through
the Director of the Office of Rural Health, may carry out demonstration
projects to examine the feasibility and advisability of alternatives for
expanding care for veterans in rural areas, which may include the
following:</text>
<paragraph commented="no" display-inline="no-display-inline" id="idFC3BBE673EF14AB686C6DDB8067FF4BA"><enum>(1)</enum><text display-inline="yes-display-inline">Establishing a partnership between the
Department of Veterans Affairs and the Centers for Medicare and Medicaid
Services of the Department of Health and Human Services to coordinate care for
veterans in rural areas at critical access hospitals (as designated or
certified under section 1820 of the Social Security Act (42 U.S.C.
1395i–4)).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8607C4540598483BBF2E19D4E7FC87C4"><enum>(2)</enum><text display-inline="yes-display-inline">Establishing a partnership between the
Department of Veterans Affairs and the Department of Health and Human Services
to coordinate care for veterans in rural areas at community health
centers.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idE31CE01CBFA84183B41635F91B7B9D4A"><enum>(3)</enum><text display-inline="yes-display-inline">Expanding coordination between the
Department of Veterans Affairs and the Indian Health Service to expand care for
Indian veterans.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ID769c84c1a3864fae982dbaa7e896f8c4"><enum>(b)</enum><header display-inline="yes-display-inline">Geographic distribution</header><text display-inline="yes-display-inline">The Secretary shall ensure that the
demonstration projects carried out under subsection (a) are located at
facilities that are geographically distributed throughout the United
States.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="IDf5eacdb1028c41d98285bdc129a60015"><enum>(c)</enum><header display-inline="yes-display-inline">Report</header><text display-inline="yes-display-inline">Not later than two years after the date of
the enactment of this Act, the Secretary shall submit a report on the results
of the demonstration projects conducted under subsection (a) to—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id666C56EF43DA4A318FDE2E651153E0B4"><enum>(1)</enum><text display-inline="yes-display-inline">the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id07865837217D42F2A4EE59F077A150CD"><enum>(2)</enum><text display-inline="yes-display-inline">the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of Representatives.</text>
</paragraph></subsection></section><section id="id25EA4AA45B644EFF985EF356C4C3ED4F" section-type="subsequent-section"><enum>206.</enum><header>Program on provision
of readjustment and mental health care services to veterans who served in
Operation Iraqi Freedom and Operation Enduring Freedom</header>
<subsection id="idFEB383D1ECAF4D06A195EE774DA790E1"><enum>(a)</enum><header>Program
required</header><text>Not later than 180 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall establish a program to
provide—</text>
<paragraph id="idA90CA90912FF4CAF939AA470704EA546"><enum>(1)</enum><text>to veterans of Operation
Iraqi Freedom and Operation Enduring Freedom, particularly veterans who served
in such operations while in the National Guard and the Reserves—</text>
<subparagraph id="idC88CEFE3C0474B7D920814644BE2D4F9"><enum>(A)</enum><text>peer outreach
services;</text>
</subparagraph><subparagraph id="id958372749D4B4EDAB1B9DE699D12AFCC"><enum>(B)</enum><text>peer support
services;</text>
</subparagraph><subparagraph id="id72C96640DCF446F8BE972666D997035E"><enum>(C)</enum><text>readjustment counseling
and services described in section 1712A of title 38, United States Code;
and</text>
</subparagraph><subparagraph id="id8846960878BE49CE8AE85712EDF333F4"><enum>(D)</enum><text>mental health services;
and</text>
</subparagraph></paragraph><paragraph id="id3E4BDE121290404DBB235CD6D9B38CB5"><enum>(2)</enum><text>to members of the
immediate family of such a veteran, during the three-year period beginning on
the date of the return of such veteran from deployment in Operation Iraqi
Freedom or Operation Enduring Freedom, education, support, counseling, and
mental health services to assist in—</text>
<subparagraph id="idB409C6750EAC47E59C570C723315E49B"><enum>(A)</enum><text>the readjustment of such
veteran to civilian life;</text>
</subparagraph><subparagraph id="idD883CCF1845C4331A34EE0A84B2BC52F"><enum>(B)</enum><text>in the case such veteran
has an injury or illness incurred during such deployment, the recovery of such
veteran; and</text>
</subparagraph><subparagraph id="idCCD19254D9BB4B9AA1E33DD7E3E75F7E"><enum>(C)</enum><text>the readjustment of the
family following the return of such veteran.</text>
</subparagraph></paragraph></subsection><subsection id="id79C8A9543FD747E291C89176F1F2F069"><enum>(b)</enum><header>Contracts with
community mental health centers and qualified entities for provision of
services</header><text>In carrying out the program required by subsection (a),
the Secretary shall contract with community mental health centers and other
qualified entities to provide the services required by such subsection only in
areas the Secretary determines are not adequately served by other health care
facilities or vet centers of the Department of Veterans Affairs. Such contracts
shall require each contracting community health center or entity—</text>
<paragraph id="id8036CC86417F409596DBE8410B2FA6DC"><enum>(1)</enum><text>to the extent
practicable, to use telehealth services for the delivery of services required
by subsection (a);</text>
</paragraph><paragraph id="id70D4520EDA7C4EBEA41130866D38986C"><enum>(2)</enum><text>to the extent
practicable, to employ veterans trained under subsection (c);</text>
</paragraph><paragraph id="id7419FFFAF2234574B9D9D01020F9673A"><enum>(3)</enum><text>to participate in the
training program conducted in accordance with subsection (d);</text>
</paragraph><paragraph commented="no" id="id99394EA181FD49D38583362EA615CC1D"><enum>(4)</enum><text>to comply with applicable
protocols of the Department before incurring any liability on behalf of the
Department for the provision of the services required by subsection (a);</text>
</paragraph><paragraph id="id1E1808AB3FA5477F895A19B8765D6649"><enum>(5)</enum><text>for each veteran for whom
a community mental health center or other qualified entity provides mental
health services under such contract, to provide the Department with such
clinical summary information as the Secretary shall require;</text>
</paragraph><paragraph id="id6296262B095641598872028122DDB519"><enum>(6)</enum><text>to submit annual reports
to the Secretary containing, with respect to the program required by subsection
(a) and for the last full calendar year ending before the submission of such
report—</text>
<subparagraph id="idF936B677E3AD49E28A3054533C749ECD"><enum>(A)</enum><text>the number of the
veterans served, veterans diagnosed, and courses of treatment provided to
veterans as part of the program required by subsection (a); and</text>
</subparagraph><subparagraph id="idC3A1B02BE5844C0484A6CFB0BC0B72BE"><enum>(B)</enum><text>demographic information
for such services, diagnoses, and courses of treatment; and</text>
</subparagraph></paragraph><paragraph id="id00F4B38FB52B4E139D38972E8F7CB31F"><enum>(7)</enum><text>to meet such other
requirements as the Secretary shall require.</text>
</paragraph></subsection><subsection id="idEE55535843D24DEF8C733CC0D799532A"><enum>(c)</enum><header>Training of veterans
for the provision of peer-outreach and peer-support services</header><text>In
carrying out the program required by subsection (a), the Secretary shall
contract with a national not-for-profit mental health organization to carry out
a national program of training for veterans described in subsection (a) to
provide the services described in subparagraphs (A) and (B) of paragraph (1) of
such subsection.</text>
</subsection><subsection id="id4835BF1D0F454502895CDC615AF444A7"><enum>(d)</enum><header>Training of clinicians
for provision of services</header><text>The Secretary shall conduct a training
program for clinicians of community mental health centers or entities that have
contracts with the Secretary under subsection (b) to ensure that such
clinicians can provide the services required by subsection (a) in a manner
that—</text>
<paragraph id="id240A80F9DCEA42C1AB88B075901FB60B"><enum>(1)</enum><text>recognizes factors that
are unique to the experience of veterans who served on active duty in Operation
Iraqi Freedom or Operation Enduring Freedom (including their combat and
military training experiences); and</text>
</paragraph><paragraph id="id85CCF96639D8411B9813F6322AFB6D93"><enum>(2)</enum><text>utilizes best practices
and technologies.</text>
</paragraph></subsection><subsection id="id640F8F57D63F404BAF53F62285EBAF06"><enum>(e)</enum><header>Reports
required</header>
<paragraph id="id7C3C64BCBA934D93A2F121F228CA04A8"><enum>(1)</enum><header>Initial report on plan
for implementation</header><text>Not later than 45 days after the date of the
enactment of this Act, the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the House of
Representatives a report containing the plans of the Secretary to implement the
program required by subsection (a).</text>
</paragraph><paragraph id="id68D4226E6D2548DDA34D6CC176B80023"><enum>(2)</enum><header>Status
report</header><text>Not later than one year after the date of the enactment of
this Act, the Secretary shall submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of the House of
Representatives a report on the implementation of the program. Such report
shall include the following:</text>
<subparagraph id="id86FC35F303D84E109D3B18FA970B7102"><enum>(A)</enum><text>Information on the number
of veterans who received services as part of the program and the type of
services received during the last full calendar year completed before the
submission of such report.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id716B8C7EF6DF443695B04148C88C82D0"><enum>(B)</enum><text>An evaluation of the
provision of services under paragraph (2) of subsection (a) and a
recommendation as to whether the period described in such paragraph should be
extended to a five-year period.</text>
</subparagraph></paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id4258A37967F747FE8F6B6A9944450E5E"><enum>207.</enum><header>Improvement of care of
American Indian veterans</header>
<subsection id="id26A84813FEBA4C7E93E66195BBF66A8A"><enum>(a)</enum><header>Indian Health
Coordinators</header>
<paragraph id="id3F65456253A64FD3ABB272AA01B95607"><enum>(1)</enum><header>In
general</header><text>Subchapter II of chapter 73 is amended by adding at the
end the following new section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id94F828CE69394B2A9445C4F50F3F70EB" reported-display-style="italic" style="USC">
<section id="idE9ACE5EEFDFE4587B636340ABDEA2F58"><enum>7330B.</enum><header>Indian Veterans
Health Care Coordinators</header>
<subsection id="idD0079CF43BEB4391BBFB5FF6D887C5ED"><enum>(a)</enum><header>In
general</header><paragraph commented="no" display-inline="yes-display-inline" id="idE39F405242D64C4AA1A414CAB8CFCB82"><enum>(1)</enum><text>The Secretary shall
assign at each of the 10 Department Medical Centers that serve communities with
the greatest number of Indian veterans per capita an official or employee of
the Department to act as the coordinator of health care for Indian veterans at
such Medical Center. The official or employee so assigned at a Department
Medical Center shall be known as the <quote>Indian Veterans Health Care
Coordinator</quote> for the Medical Center.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id76804FBB5B244C769A5446BB1C22662F" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall, from
time to time—</text>
<subparagraph id="id0C17414C2F924154AA04B9096CAE9BA6"><enum>(A)</enum><text>survey the Department
Medical Centers for purposes of identifying the 10 Department Medical Centers
that currently serve communities with the greatest number of Indian veterans
per capita; and</text>
</subparagraph><subparagraph id="id920232F04C3A49398EBB6FB9555CD30B"><enum>(B)</enum><text>utilizing the results of
the most recent survey conducted under subparagraph (A), revise the assignment
of Indian Veterans Health Care Coordinators in order to assure the assignment
of such coordinators to appropriate Department Medical Centers as required by
paragraph (1).</text>
</subparagraph></paragraph></subsection><subsection id="idA325CCFC7D2A45CE8EB97BD1464FB08B"><enum>(b)</enum><header>Duties</header><text>The
duties of an Indian Veterans Health Care Coordinator shall include the
following:</text>
<paragraph id="id31D24CCD27654BBF8D2768AE503158AF"><enum>(1)</enum><text>Improving outreach to
tribal communities.</text>
</paragraph><paragraph id="idB3A8D0544C714712B0B832341FCC40E0"><enum>(2)</enum><text>Coordinating the medical
needs of Indian veterans on Indian reservations with the Veterans Health
Administration and the Indian Health Service.</text>
</paragraph><paragraph id="id77FBC4DEA6D441CBB771E47586B7B3EE"><enum>(3)</enum><text>Expanding the access and
participation of the Department of Veterans Affairs, the Indian Health Service,
and tribal members in the Department of Veterans Affairs Tribal Veterans
Representative program.</text>
</paragraph><paragraph id="idFF65388435334846A8911E0A879A51F4"><enum>(4)</enum><text>Acting as an ombudsman
for Indian veterans enrolled in the health care system of the Veterans Health
Administration.</text>
</paragraph><paragraph id="id68E2EE59FCA641368C457667F7CAD002"><enum>(5)</enum><text>Advocating for the
incorporation of traditional medicine and healing in Department treatment plans
for Indian veterans in need of care and services provided by the
Department.</text>
</paragraph></subsection><subsection id="idF58B4913A64B4866BCC250E980FA9BCC"><enum>(c)</enum><header>Indian
defined</header><text>In this section, the term <term>Indian</term> has the
meaning given the term in section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C.
450b).</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idAF09812DA3764BE6BDA672C6CBD3ABFF"><enum>(2)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections at the beginning of
chapter 73 is amended by inserting after the item relating to section 7330A the
following new item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idEAB201F938604C84A333872885F70EEE" reported-display-style="italic" style="USC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">7330B. Indian Veterans Health
Coordinators.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id0A083E35E75A42368FA46A0AAD61990E"><enum>(b)</enum><header>Integration of
electronic health records with Indian Health Service</header><text>Not later
than one year after the date of the enactment of this Act, the Secretary of
Veterans Affairs and the Secretary of Health and Human Services shall enter
into a memorandum of understanding to ensure that the health records of Indian
veterans may be transferred electronically between facilities of the Indian
Health Service and the Department of Veterans Affairs.</text>
</subsection><subsection id="id667CFD4AB9A74B3B9AE6EFE09D6DCFA8"><enum>(c)</enum><header>Transfer of medical
equipment to the Indian Health Service</header>
<paragraph id="id051F8F8951E74581841AA1D0B56B71AA"><enum>(1)</enum><header>In
general</header><text>The Secretary of Veterans Affairs may transfer to the
Indian Health Service such surplus Department of Veterans Affairs medical and
information technology equipment as the Secretary of Veterans Affairs and the
Secretary of Health and Human Services jointly consider appropriate for
purposes of the Indian Health Service.</text>
</paragraph><paragraph id="idD95AB5C07E8D4889BD682CD038D01064"><enum>(2)</enum><header>Transportation and
installation</header><text>In transferring medical or information technology
equipment under this subsection, the Secretary of Veterans Affairs may
transport and install such equipment in facilities of the Indian Health
Service.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id7F037E78B97346049D3F7906D76936B1"><enum>(d)</enum><header>Report on Joint Health
Clinics With Indian Health Service</header><text>Not later than one year after
the date of the enactment of this Act, the Secretary of Veterans Affairs and
the Secretary of Health and Human Services shall jointly submit to Congress a
report on the feasability and advisability of the joint establishment and
operation by the Veterans Health Administration and the Indian Health Service
of health clinics on Indian reservations to serve the populations of such
reservations, including Indian veterans.</text>
</subsection></section><section id="id3D2DEE7F047E4D7CAE6E67F62B63C0D4"><enum>208.</enum><header>Travel reimbursement
for veterans receiving treatment at facilities of the Department of Veterans
Affairs</header>
<subsection commented="no" display-inline="no-display-inline" id="idDFE9F8FE43E345C0BA42A8F82CAAFE76"><enum>(a)</enum><header>Enhancement of
allowance based upon mileage traveled</header><text display-inline="yes-display-inline">Section 111 is amended—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idA9DDA3984DAD46A6B917ACB92A31AFFD"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (a), by striking
<quote>traveled,</quote> and inserting <quote>(at a rate of 41.5 cents per
mile),</quote>; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idD5E100E4342046AA8842D0513CC00D18"><enum>(2)</enum><text>by amending subsection
(g) to read as follows:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idB31101755B3F40A6B7951D8ADF0A99F1" reported-display-style="italic" style="OLC">
<subsection commented="no" display-inline="no-display-inline" id="id14035AD6423B42B7BFC03E46F4496C1C"><enum>(g)</enum><paragraph commented="no" display-inline="yes-display-inline" id="id4C528895083C45BCBCE59EC9770FA30F"><enum>(1)</enum><text>Beginning one year
after the date of the enactment of the Caregiver and Veterans Health Services
Act of 2009, the Secretary may adjust the mileage rate described in subsection
(a) to be equal to the mileage reimbursement rate for the use of privately
owned vehicles by Government employees on official business (when a Government
vehicle is available), as prescribed by the Administrator of General Services
under section 5707(b) of title 5.</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSVA00" display-inline="no-display-inline" id="id5088DC1DC0714ABC90FF78B62C6FBF07" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>If an
adjustment in the mileage rate under paragraph (1) results in a lower mileage
rate than the mileage rate otherwise specified in subsection (a), the Secretary
shall, not later than 60 days before the date of the implementation of the
mileage rate as so adjusted, submit to Congress a written report setting forth
the adjustment in the mileage rate under this subsection, together with a
justification for the decision to make the adjustment in the mileage rate under
this
subsection.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id5D3B3CD4AB324D6F8F5227C54EE428B0"><enum>(b)</enum><header>Coverage of cost of
transportation by air</header><text>Subsection (a) of section 111, as amended
by subsection (a)(1), is further amended by inserting after the first sentence
the following new sentence: <quote>Actual necessary expense of travel includes
the reasonable costs of airfare if travel by air is the only practical way to
reach a Department facility.</quote>.</text>
</subsection><subsection id="idE57DA52C61CE467D80BB932E09C93426"><enum>(c)</enum><header>Elimination of
limitation based on maximum annual rate of pension</header><text>Subsection
(b)(1)(D)(i) of such section is amended by inserting <quote>who is not
traveling by air and</quote> before <quote>whose annual</quote>.</text>
</subsection><subsection id="id7E45C6F12D474997BA2B8BDEF47AEA43"><enum>(d)</enum><header>Determination of
practicality</header><text>Subsection (b) of such section is amended by adding
at the end the following new paragraph:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id08B86EE313CB4B90B204C1F6B29C39F5" reported-display-style="italic" style="USC">
<paragraph id="id04C61602ABC744C583B792CED34B77CD" indent="up1"><enum>(4)</enum><text>In determining for
purposes of subsection (a) whether travel by air is the only practical way for
a veteran to reach a Department facility, the Secretary shall consider the
medical condition of the veteran and any other impediments to the use of ground
transportation by the
veteran.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="idDCBC127DEBBD4AF3A2DAD40EEBC6DF3E"><enum>(e)</enum><header>No expansion of
eligibility for beneficiary travel</header><text>The amendments made by
subsections (b) and (d) of this section may not be construed as expanding or
otherwise modifying eligibility for payments or allowances for beneficiary
travel under section 111 of title 38, United States Code, as in effect on the
day before the date of the enactment of this Act.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id9C83C276B75345A1A1314A695BA3A17D"><enum>(f)</enum><header>Clarification of
relation to public transportation in Veterans Health Administration
Handbook</header><text>Not later than 30 days after the date of the enactment
of this Act, the Secretary of Veterans Affairs shall revise the Veterans Health
Administration Handbook to clarify that an allowance for travel based on
mileage paid under section 111(a) of title 38, United States Code, may exceed
the cost of such travel by public transportation regardless of medical
necessity.</text>
</subsection></section><section id="idBBA8ACA089344F34959BA9DF29115ECF"><enum>209.</enum><header>Office of Rural Health
five-year strategic plan</header>
<subsection id="id72067DB6D357416FB0764E3CC59BADA8"><enum>(a)</enum><header>Strategic
plan</header><text>Not later than 180 days after the date of the enactment of
this Act, the Director of the Office of Rural Health of the Department of
Veterans Affairs shall develop a five-year strategic plan for the Office of
Rural Health.</text>
</subsection><subsection id="idDE24961CE4FA4D6AAAEED12CB75F129E"><enum>(b)</enum><header>Contents</header><text>The
plan required by subsection (a) shall include the following:</text>
<paragraph id="idF8A8E72DF1E445F5A1DC7DD6BF15769D"><enum>(1)</enum><text>Specific goals for the
recruitment and retention of health care personnel in rural areas, developed in
conjunction with the Director of the Health Care Retention and Recruitment
Office of the Department of Veterans Affairs.</text>
</paragraph><paragraph id="id3E9E5A0011B4417BA5EAE817063FFD35"><enum>(2)</enum><text>Specific goals for
ensuring the timeliness and quality of health care delivery in rural
communities that are reliant on contract and fee-basis care, developed in
conjunction with the Director of the Office of Quality and Performance of the
Department.</text>
</paragraph><paragraph id="id66325821D08D4F5EB4893159A7FAF367"><enum>(3)</enum><text>Specific goals for the
expansion and implementation of telemedicine services in rural areas, developed
in conjunction with the Director of the Office of Care Coordination Services of
the Department.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id53DAD51631384C2B89705B6B307E3233"><enum>(4)</enum><text>Incremental milestones
describing specific actions to be taken for the purpose of achieving the goals
specified under paragraphs (1) through (3).</text>
</paragraph></subsection></section><section id="idB245D96C66DA4ED7B84D22A0D21DCCA5"><enum>210.</enum><header>Oversight of contract
and fee-basis care</header>
<subsection id="idFE4022DAB004415897670473BB0788A2"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subchapter I of
chapter 17 is amended by inserting after section 1703 the following new
section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id6840EB7ED70C4768AC72B35639F783D4" reported-display-style="italic" style="USC">
<section id="id1C53E299EB9946D3B3E9CCC4CD98066F"><enum>1703A.</enum><header>Oversight of
contract and fee-basis care</header>
<subsection id="id6FFA677576E343FFBFEBD23865428E2A"><enum>(a)</enum><header>Rural outreach
coordinators</header><text>The Secretary shall designate a rural outreach
coordinator at each Department community based outpatient clinic at which not
less than 50 percent of the veterans enrolled at such clinic reside in a highly
rural area. The coordinator at a clinic shall be responsible for coordinating
care and collaborating with community contract and fee-basis providers with
respect to the clinic.</text>
</subsection><subsection id="id36359362D8644C0999B1D3A876DA747B"><enum>(b)</enum><header>Incentives To obtain
accreditation of medical practice</header><paragraph commented="no" display-inline="yes-display-inline" id="id6CDD011FC1B84EB6857C430B33F85138"><enum>(1)</enum><text>The Secretary shall
adjust the fee-basis compensation of providers of health care services under
the Department to encourage such providers to obtain accreditation of their
medical practice from recognized accrediting entities.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id986F6848682646E997AFADD151BD9974" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>In making adjustments
under paragraph (1), the Secretary shall consider the increased overhead costs
of accreditation described in paragraph (1) and the costs of achieving and
maintaining such accreditation.</text>
</paragraph></subsection><subsection id="id944DF35B48A84A48BA97E6CA366595C9"><enum>(c)</enum><header>Incentives for
participation in peer review</header><paragraph commented="no" display-inline="yes-display-inline" id="id7BC60B79970F4BD6959131BCAB78A307"><enum>(1)</enum><text>The Secretary shall
adjust the fee-basis compensation of providers of health care services under
the Department that do not provide such services as part of a medical practice
accredited by a recognized accrediting entity to encourage such providers to
participate in peer review under subsection (e).</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idD86BBD49BDD9449D8C1385DB6629B50F" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>The Secretary shall
provide incentives under paragraph (1) to a provider of health care services
under the Department in an amount which may reasonably be expected (as
determined by the Secretary) to encourage participation in the voluntary peer
review under subsection (d).</text>
</paragraph></subsection><subsection id="idEFCD800C65F740ACB2FF9C3542A2C8DF"><enum>(d)</enum><header>Peer
review</header><paragraph commented="no" display-inline="yes-display-inline" id="id52A1D136A00C442799D2D8A028637785"><enum>(1)</enum><text>The Secretary shall
provide for the voluntary peer review of providers of health care services
under the Department who provide such services on a fee basis as part of a
medical practice that is not accredited by a recognized accrediting
entity.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id0A7598E14863460491D1600CE40E6737" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>Each year, beginning with
the first fiscal year beginning after the date of the enactment of this
section, the Chief Quality and Performance Officer in each Veterans Integrated
Services Network (VISN) shall select a sample of patient records from each
participating provider in the Officer's Veterans Integrated Services Network to
be peer reviewed by a facility designated under paragraph (3).</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id80171FCBAC344EFB8599186A964456E1" indent="up1" reported-display-style="italic"><enum>(3)</enum><text>The Chief Quality and
Performance Officer in each Veterans Integrated Services Network shall
designate Department facilities in such network for the peer review of patient
records submitted under this subsection.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idFF098891326C4F1AB43FE6891CC5E048" indent="up1" reported-display-style="italic"><enum>(4)</enum><text>Each year, beginning with
the first fiscal year beginning after the date of the enactment of this
section, each provider who elects to participate in the program shall submit
the patient records selected under paragraph (2) to a facility selected under
paragraph (3) to be peer reviewed by such facility.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="id2915B227A8F4402A8B0E17E46B4FFA2B" indent="up1" reported-display-style="italic"><enum>(5)</enum><text>Each Department facility
designated under paragraph (3) that receives patient records under paragraph
(4) shall—</text>
<subparagraph id="id2DF8A10FF6A644F9B209544E3FC0DB0C"><enum>(A)</enum><text>peer review such records
in accordance with policies and procedures established by the Secretary;</text>
</subparagraph><subparagraph id="id235201799D89444CB35B9C2786F10D4A"><enum>(B)</enum><text>ensure that peer reviews
are evaluated by the Peer Review Committee; and</text>
</subparagraph><subparagraph id="idFBF361D735484266984D50010BCE18A0"><enum>(C)</enum><text>develop a mechanism for
notifying the Under Secretary for Health of problems identified through such
peer review.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSVA00" id="id7D6DDBD13EB64CE89877980C5BB7991D" indent="up1" reported-display-style="italic"><enum>(6)</enum><text>The Under Secretary for
Health shall develop a mechanism by which the use of fee-basis providers of
health care are terminated when quality of care concerns are identified with
respect to such providers.</text>
</paragraph><paragraph changed="added" committee-id="SSVA00" id="idD8D28A728EEB49398165A03CD0014701" indent="up1" reported-display-style="italic"><enum>(7)</enum><text>The Chief Quality and
Performance Officer in each Veterans Integrated Services Network shall be
responsible for the oversight of the program of peer review under this
subsection in that
network.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id6550128500434B6ABF90B70855A9E455"><enum>(b)</enum><header>Clerical
amendment</header><text>The table of sections at the beginning of chapter 17 is
amended by inserting after the item related to section 1703 the following new
item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id9D55AB7AA5B449D89BC07A6A58743C3C" reported-display-style="italic" style="USC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">1703A. Oversight of contract
and fee-basis
care.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="id379261EF0558438480A885960B14582A"><enum>211.</enum><header>Enhancement of Vet
Centers to meet needs of veterans of Operation Iraqi Freedom and Operation
Enduring Freedom</header>
<subsection id="id0983300D331A4D6AAFFC5BC27053211A"><enum>(a)</enum><header>Volunteer
counselors</header>
<paragraph id="id9A8B08442005400BBA039BF9EA6384B9"><enum>(1)</enum><header>In
general</header><text>Subsection (c) of section 1712A is amended—</text>
<subparagraph id="id9D4E5303B2184F34B1EE9594BD2825E1"><enum>(A)</enum><text>by striking <quote>The
Under Secretary</quote> and inserting <quote>(1) The Under
Secretary</quote>;</text>
</subparagraph><subparagraph id="idFEBF86CA80984271B25233DAE1457891"><enum>(B)</enum><text>in paragraph (1), as
designated by paragraph (1), by striking <quote>, and, in carrying</quote> and
all that follows through <quote>screening activities</quote>; and</text>
</subparagraph><subparagraph id="idC0B237B672C9480D82CF6E8D2290D1FE"><enum>(C)</enum><text>by adding at the end the
following new paragraphs:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id98017FA9BF7344BDB1805C3CC50DEF9D" reported-display-style="italic" style="OLC">
<paragraph id="id932994DEF078437F8B932747893ACAD3" indent="up1"><enum>(2)</enum><text>In carrying out this
section, the Under Secretary may utilize the services of the following:</text>
<subparagraph id="id39A738DA8C244094A6A2772F2E326DB2"><enum>(A)</enum><text>Paraprofessionals,
individuals who are volunteers working without compensation, and individuals
who are veteran-students (as described in section 3485 of this title) in
initial intake and screening activities.</text>
</subparagraph><subparagraph id="idB33D4FA8A7D04896B69621ED4B0D0205"><enum>(B)</enum><text>Eligible volunteer
counselors in the provision of counseling and related mental health
services.</text>
</subparagraph></paragraph><paragraph id="id94953CEA29A6459DBCBBD27D9B2BA536" indent="up1"><enum>(3)</enum><text>For purposes of this
subsection, an eligible volunteer counselor is an individual—</text>
<subparagraph id="id1F20F892CA6D4531B2254A04C524E80F"><enum>(A)</enum><text>who—</text>
<clause id="id3EF25DBA05A844CBB9C70061468DA349"><enum>(i)</enum><text>provides counseling
services without compensation at a center;</text>
</clause><clause id="idA45EE9CF1E044690A8A42E7B155129C4"><enum>(ii)</enum><text>is a licensed
psychologist or social worker;</text>
</clause><clause id="id5169A697964D486482C8717BA35CCE28"><enum>(iii)</enum><text>has never been named in
a tort claim arising from professional activities; and</text>
</clause><clause id="idDE968F1934D34102B432B0E724967198"><enum>(iv)</enum><text>has never had, and has
no pending, disciplinary action taken with respect to any license or
certification qualifying that individual to provide counseling services;
or</text>
</clause></subparagraph><subparagraph id="id7BD90713E3C04BCEA3E948BE66B0D86B"><enum>(B)</enum><text>who is otherwise
credentialed and privileged to perform counseling services by the
Secretary.</text>
</subparagraph></paragraph><paragraph id="id90DA5CEA7F894D23BFAFFF28365D584A" indent="up1"><enum>(4)</enum><text>Eligible volunteer
counselors shall be issued credentials and privileges for the provision of
counseling and related mental health services under this section on an
expedited basis in accordance with such procedures as the Secretary shall
establish. Such procedures shall provide for the completion by the Secretary of
the processing of an application for such credentials and privileges not later
than 60 days after receipt of the
application.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="id9DD3964FD6E243D5A830980692A7A7C2"><enum>(2)</enum><header>Procedures for issuing
credentials and privileges to volunteer counselors</header><text>Not later than
one year after the date of the enactment of this Act, the Secretary of Veterans
Affairs shall establish the procedures described in section 1712A(c)(4), as
added by paragraph (1).</text>
</paragraph></subsection><subsection id="id888DF77AEA324146AEAF0DC8783936C1"><enum>(b)</enum><header>Outreach</header><text>Subsection
(e) of such section is amended—</text>
<paragraph id="id7633144218EE4B209AAACD0022802C59"><enum>(1)</enum><text>by striking <quote>The
Secretary</quote> and inserting <quote>(1) The Secretary</quote>; and</text>
</paragraph><paragraph id="id0CD3294B5BA841B8AE3DC1D2EB48C28A"><enum>(2)</enum><text>by adding at the end the
following new paragraph:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idD371BE0493F547A0A0ABD9E2CB87D98A" reported-display-style="italic" style="USC">
<paragraph commented="no" display-inline="no-display-inline" id="id9DDA89C8BD83407AAFF3C72DF81C0829" indent="up1"><enum>(2)</enum><text>Each
center shall develop an outreach plan to ensure that the community served by
the center is aware of the services offered by the
center.</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id6321ECC1F71E4F7BBEB629F8045E7A13" section-type="subsequent-section"><enum>212.</enum><header display-inline="yes-display-inline">Centers of excellence for rural health
research, education, and clinical activities</header>
<subsection commented="no" display-inline="no-display-inline" id="id87FF042FA08A449ABFBEAF9E6EB82622"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Subchapter II of chapter 73, as amended by
section 214 of this Act, is further amended by adding at the end the following
new section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="id6E76F5A0E0954A7BA05EBBA32F563D50" reported-display-style="italic" style="USC">
<section commented="no" display-inline="no-display-inline" id="id7B82C51F070D4C3DAC53DE81BA13B322" section-type="subsequent-section"><enum>7330C.</enum><header display-inline="yes-display-inline">Centers of excellence for rural health
research, education, and clinical activities</header>
<subsection commented="no" display-inline="no-display-inline" id="idFFEAD320BFFA4D739F916B55E57D2F5F"><enum>(a)</enum><header display-inline="yes-display-inline">Establishment of centers</header><text display-inline="yes-display-inline">The Secretary, through the Director of the
Office of Rural Health, shall establish and operate at least one and not more
than five centers of excellence for rural health research, education, and
clinical activities, which shall—</text>
<paragraph commented="no" display-inline="no-display-inline" id="idAA02DA6ED7B24369AD05FC07D41053E6"><enum>(1)</enum><text display-inline="yes-display-inline">conduct research on the furnishing of
health services in rural areas;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1BC25B304D7A4B2CB5AED65C411413A6"><enum>(2)</enum><text display-inline="yes-display-inline">develop specific models to be used by the
Department in furnishing health services to veterans in rural areas;</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idC563C6DA6F484E34A5FF8640163E767F"><enum>(3)</enum><text display-inline="yes-display-inline">provide education and training for health
care professionals of the Department on the furnishing of health services to
veterans in rural areas; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id329AB1485C0E4676A673C3C0CB103A19"><enum>(4)</enum><text display-inline="yes-display-inline">develop and implement innovative clinical
activities and systems of care for the Department for the furnishing of health
services to veterans in rural areas.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id87948FFB66424A95833D2557219FE7C6"><enum>(b)</enum><header>Use of rural health
resource centers</header><text display-inline="yes-display-inline">In selecting
locations for the establishment of centers of excellence under subsection (a),
the Secretary may select a rural health resource center that meets the
requirements of subsection (a).</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idD6823EE56AA0465094D09748F55448DE"><enum>(c)</enum><header display-inline="yes-display-inline">Geographic dispersion</header><text display-inline="yes-display-inline">The Secretary shall ensure that the centers
established under this section are located at health care facilities that are
geographically dispersed throughout the United States.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id01650C536FC14276B5887A8886F0CB3C"><enum>(d)</enum><header display-inline="yes-display-inline">Funding</header><paragraph commented="no" display-inline="yes-display-inline" id="id827174E3C422446F85AD23581032D728"><enum>(1)</enum><text display-inline="yes-display-inline">There are authorized to be appropriated to
the Medical Care Account and the Medical and Prosthetics Research Account of
the Department of Veterans Affairs such sums as may be necessary for the
support of the research and education activities of the centers operated under
this section.</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSVA00" display-inline="no-display-inline" id="id6886787C9A5B429EBF247C65B0D88D0B" indent="up1" reported-display-style="italic"><enum>(2)</enum><text display-inline="yes-display-inline">There shall be allocated to the centers
operated under this section, from amounts authorized to be appropriated to the
Medical Care Account and the Medical and Prosthetics Research Account by
paragraph (1), such amounts as the Under Secretary of health considers
appropriate for such centers. Such amounts shall be allocated through the
Director of the Office of Rural Health.</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSVA00" display-inline="no-display-inline" id="id7B3418B846CD4A42AECF9EB31EF69FD0" indent="up1" reported-display-style="italic"><enum>(3)</enum><text display-inline="yes-display-inline">Activities of clinical and scientific
investigation at each center operated under this section—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id877442D28EB04A05BB161953DEB50030"><enum>(A)</enum><text display-inline="yes-display-inline">shall be eligible to compete for the award
of funding from funds appropriated for the Medical and Prosthetics Research
Account; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id67BDCC1C570946F998EEE18FBCDEBFA1"><enum>(B)</enum><text display-inline="yes-display-inline">shall receive priority in the award of
funding from such account to the extent that funds are awarded to projects for
research in the care of rural
veterans.</text>
</subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id0F0E322169C944399CFF15252C0B9A77"><enum>(b)</enum><header display-inline="yes-display-inline">Clerical amendment</header><text display-inline="yes-display-inline">The table of sections at the beginning of
chapter 73, as amended by section 214 of this Act, is further amended by
inserting after the item relating to section 7330B the following new
item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idBDE827F1EFC94297B5CA366B9A68B9E2" reported-display-style="italic" style="USC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">7330C. Centers of excellence
for rural health research, education, and clinical
activities.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idB2C05A9AB6404DC5B9AA72909B7C6406" section-type="subsequent-section"><enum>213.</enum><header>Pilot program on
incentives for physicians who assume inpatient responsibilities at community
hospitals in health professional shortage areas</header>
<subsection id="id27DFCF303B7746AF868BC14D831F955A"><enum>(a)</enum><header>Pilot program
required</header><text>The Secretary of Veterans Affairs shall carry out a
pilot program to assess the feasability and advisability of each of the
following:</text>
<paragraph id="id1B7CB01140294C0DA59180648E7B2BE6"><enum>(1)</enum><text>The provision of
financial incentives to eligible physicians who obtain and maintain inpatient
privileges at community hospitals in health professional shortage areas in
order to facilitate the provision by such physicians of primary care and mental
health services to veterans at such hospitals.</text>
</paragraph><paragraph id="idAA5AF54027AF4895B5359DEF86252A33"><enum>(2)</enum><text>The collection of
payments from third-party providers for care provided by eligible physicians to
nonveterans while discharging inpatient responsibilities at community hospitals
in the course of exercising the privileges described in paragraph (1).</text>
</paragraph></subsection><subsection id="id12EFFABB0DDC4658BD0E7F940A26AD47"><enum>(b)</enum><header>Eligible
physicians</header><text>For purposes of this section, an eligible physician is
a primary care or mental health physician employed by the Department of
Veterans Affairs on a full-time basis.</text>
</subsection><subsection id="idE1C4DB97DD414BD7A6F45CBE8C5C76FB"><enum>(c)</enum><header>Duration of
program</header><text>The pilot program shall be carried out during the
three-year period beginning on the date of the commencement of the pilot
program.</text>
</subsection><subsection id="idD63E0F9C25354B8C8BCEBCE75D023B78"><enum>(d)</enum><header>Locations</header>
<paragraph id="id91585426F1FD41D18648E8EA67B58224"><enum>(1)</enum><header>In
general</header><text>The pilot program shall be carried out at not less than
five community hospitals in each of not less than two Veterans Integrated
Services Networks (VISNs). The hospitals shall be selected by the Secretary
utilizing the results of the survey required under subsection (e).</text>
</paragraph><paragraph id="id5BD5CBCA6BFF4C9785A0C1350995BACD"><enum>(2)</enum><header>Qualifying community
hospitals</header><text>A community hospital may be selected by the Secretary
as a location for the pilot program if—</text>
<subparagraph id="idB87774B437554F448C584E1C56D37962"><enum>(A)</enum><text>the hospital is located
in a health professional shortage area; and</text>
</subparagraph><subparagraph id="idD1188C6F507A45E5BC6F24AEDE101204"><enum>(B)</enum><text>the number of eligible
physicians willing to assume inpatient responsibilities at the hospital (as
determined utilizing the result of the survey) is sufficient for purposes of
the pilot program.</text>
</subparagraph></paragraph></subsection><subsection id="id13F4520585854FD5B82CF05306C9EE5F"><enum>(e)</enum><header>Survey of physician
interest in participation</header>
<paragraph id="id1C770A2E878A4161912B1C72707D18B3"><enum>(1)</enum><header>In
general</header><text>Not later than 120 days after the date of the enactment
of this Act, the Secretary shall conduct a survey of eligible physicians to
determine the extent of the interest of such physicians in participating in the
pilot program.</text>
</paragraph><paragraph id="id1A89C14A76F34B53880064C6780B6AD1"><enum>(2)</enum><header>Elements</header><text>The
survey shall disclose the type, amount, and nature of the financial incentives
to be provided under subsection (h) to physicians participating in the pilot
program.</text>
</paragraph></subsection><subsection id="id8791827DB95540DC9B6B9465DCD783EF"><enum>(f)</enum><header>Physician
participation</header>
<paragraph id="id19C99C7F5D4A4F5681764D578DC744AE"><enum>(1)</enum><header>In
general</header><text>The Secretary shall select physicians for participation
in the pilot program from among eligible physicians who—</text>
<subparagraph id="id764C640535B443F799F063CAB11C4C29"><enum>(A)</enum><text>express interest in
participating in the pilot program in the survey conducted under subsection
(e);</text>
</subparagraph><subparagraph id="id46031C4764214B138791FC25E0B800FE"><enum>(B)</enum><text>are in good standing with
the Department; and</text>
</subparagraph><subparagraph id="id6AED4AE0DA3A4C16BE9A5ECC9B6CE537"><enum>(C)</enum><text>primarily have clinical
responsibilities with the Department.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id08EF8054F807492B9FE48B93592C79CF"><enum>(2)</enum><header>Voluntary
participation</header><text>Participation in the pilot program shall be
voluntary. Nothing in this section shall be construed to require a physician
working for the Department to assume inpatient responsibilities at a community
hospital unless otherwise required as a term or condition of employment with
the Department.</text>
</paragraph></subsection><subsection id="idED72DC74B791463BA06985C955966125"><enum>(g)</enum><header>Assumption of inpatient
physician responsibilities</header>
<paragraph id="id9772BA1663BD4942ACB83A27FEFA74B9"><enum>(1)</enum><header>In
general</header><text>Each eligible physician selected for participation in the
pilot program shall assume and maintain inpatient responsibilities, including
inpatient responsibilities with respect to nonveterans, at one or more
community hospitals selected by the Secretary for participation in the pilot
program under subsection (d).</text>
</paragraph><paragraph id="id2C9BE44A36D94EDDBAF4CBE2A741FC72"><enum>(2)</enum><header>Coverage under Federal
Tort Claims Act</header><text>If an eligible physician participating in the
pilot program carries out on-call responsibilities at a community hospital
where privileges to practice at such hospital are conditioned upon the
provision of services to individuals who are not veterans while the physician
is on call for such hospital, the provision of such services by the physician
shall be considered an action within the scope of the physician's office or
employment for purposes of chapter 171 of title 28, United States Code
(commonly referred to as the <quote>Federal Tort Claims Act</quote>).</text>
</paragraph></subsection><subsection id="id19E46F66BF584EF0A4325462730D1927"><enum>(h)</enum><header>Compensation</header>
<paragraph id="idFC1D410B4786427E8ABFE484FA195BDB"><enum>(1)</enum><header>In
general</header><text>The Secretary shall provide each eligible physician
participating in the pilot program with such compensation (including pay and
other appropriate compensation) as the Secretary considers appropriate to
compensate such physician for the discharge of any inpatient responsibilities
by such physician at a community hospital for which such physician would not
otherwise be compensated by the Department as a full-time employee of the
Department.</text>
</paragraph><paragraph id="idD46442C498D1477899697AE2C034EBC8"><enum>(2)</enum><header>Written
agreement</header><text>The amount of any compensation to be provided a
physician under the pilot program shall be specified in a written agreement
entered into by the Secretary and the physician for purposes of the pilot
program.</text>
</paragraph><paragraph id="idC512D072834B46D8A480A86B3732ECA4"><enum>(3)</enum><header>Treatment of
compensation</header><text>The Secretary shall consult with the Director of the
Office of Personnel Management on the inclusion of a provision in the written
agreement required under paragraph (2) that describes the treatment under
Federal law of any compensation provided a physician under the pilot program,
including treatment for purposes of retirement under the civil service
laws.</text>
</paragraph></subsection><subsection id="id0B6BE5235974481C98B950A9DFCC8765"><enum>(i)</enum><header>Collections from third
parties</header><text>In carrying out the pilot program for the purpose
described in subsection (a)(2), the Secretary shall implement a variety and
range of requirements and mechanisms for the collection from third-party payors
of amounts to reimburse the Department for health care services provided to
nonveterans under the pilot program by eligible physicians discharging
inpatient responsibilities under the pilot program.</text>
</subsection><subsection id="id6D1A3D06A22F4950A313362D5416CB85"><enum>(j)</enum><header>Inpatient
responsibilities defined</header><text>In this section, the term
<term>inpatient responsibilities</term> means on-call responsibilities
customarily required of a physician by a community hospital as a condition of
granting privileges to the physician to practice in the hospital.</text>
</subsection><subsection id="id486B43A2D797417FBB8E94E5412239B2"><enum>(k)</enum><header>Report</header><text>Not
later than one year after the date of the enactment of this Act and annually
thereafter, the Secretary shall submit to Congress a report on the pilot
program, including the following:</text>
<paragraph id="idB56E3EFD215642D99803695E1D36107E"><enum>(1)</enum><text>The findings of the
Secretary with respect to the pilot program.</text>
</paragraph><paragraph id="id3BF85342695749C2B9F4497E54B01371"><enum>(2)</enum><text>The number of veterans
and nonveterans provided inpatient care by physicians participating in the
pilot program.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1E3F237510EC4905BF33C1E14ADCB223"><enum>(3)</enum><text>The amounts collected and
payable under subsection (i).</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id7DEC39D22EF441708CBD43CE5727FA1B"><enum>(l)</enum><header>Health professional
shortage area defined</header><text>In this section, the term <term>health
professional shortage area</term> has the meaning given the term in section
332(a) of the Public Health Service Act (42 U.S.C. 254e(a)).</text>
</subsection></section><section commented="no" display-inline="no-display-inline" id="id3A30CB1EF0B445BE95AD3FB1E8ED7B97" section-type="subsequent-section"><enum>214.</enum><header display-inline="yes-display-inline">Annual report on matters related to care
for veterans who live in rural areas</header>
<subsection commented="no" display-inline="no-display-inline" id="id752A034D34264FABA88A71809651E803"><enum>(a)</enum><header display-inline="yes-display-inline">Annual report</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall
submit to Congress each year, together with documents submitted to Congress in
support of the budget of the President for the fiscal year beginning in such
year (as submitted pursuant to section 1105 of title 31, United States Code),
an assessment, current as of the fiscal year ending in the year before such
report is submitted, of the following:</text>
<paragraph commented="no" display-inline="no-display-inline" id="id066948CD81584AD885EFBC6268F8AD79"><enum>(1)</enum><text display-inline="yes-display-inline">The implementation of the provisions of
sections 209 through 213, including the amendments made by such
sections.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id71997B4F196E4C4699178063DE06CD3B"><enum>(2)</enum><text display-inline="yes-display-inline">The establishment and functions of the
Office of Rural Health under section 7308 of title 38, United States
Code.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id4B12279664074BD2861FC714709C1B86"><enum>(b)</enum><header display-inline="yes-display-inline">Additional requirements for initial
report</header><text display-inline="yes-display-inline">The first report
submitted under subsection (a) shall also include the following:</text>
<paragraph commented="no" display-inline="no-display-inline" id="idFA40200AA62247A99990890D3BE10E23"><enum>(1)</enum><text display-inline="yes-display-inline">The assessment of fee-basis health-care
program required by section 212(b) of the Veterans Benefits, Health Care, and
Information Technology Act of 2006 (Public Law 109–461; 120 Stat. 3422).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idE3388C29E7984ADE88FFB07DD0827F8F"><enum>(2)</enum><text display-inline="yes-display-inline">An assessment of the outreach program
required by section 213 of such Act (120 Stat. 3422; 38 U.S.C. 6303
note).</text>
</paragraph></subsection></section><section commented="no" display-inline="no-display-inline" id="id88BF4F3B492D4B73B6BD06198E9CD220" section-type="subsequent-section"><enum>215.</enum><header display-inline="yes-display-inline">Transportation grants for rural veterans
service organizations</header>
<subsection commented="no" display-inline="no-display-inline" id="id94D119728B0646C7B8187F3AD95C5C26"><enum>(a)</enum><header display-inline="yes-display-inline">Grants authorized</header>
<paragraph commented="no" display-inline="no-display-inline" id="id664C82D4D12D49DDB6ECC71460C0A47E"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall
establish a grant program to provide innovative transportation options to
veterans in highly rural areas.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5CA8CF32E9B94325B2111BCF03B65F3B"><enum>(2)</enum><header>Eligible
recipients</header><text>The following may be awarded a grant under this
section:</text>
<subparagraph commented="no" display-inline="no-display-inline" id="idC7F8B501EC4D47EDA8C219564F972043"><enum>(A)</enum><text>State veterans service
agencies.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id8BAF4E839B134B94A8427797A775FADD"><enum>(B)</enum><text>Veterans service
organizations.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idBB88B918AF7741B4A30E16796F7C82BA"><enum>(3)</enum><header>Use of
funds</header><text>A State veterans service agency or veterans service
organization awarded a grant under this section may use the grant amount
to—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id5D11EEF891E04161BFDF7E2D44A05E7F"><enum>(A)</enum><text display-inline="yes-display-inline">assist veterans in highly rural areas to
travel to Department of Veterans Affairs medical centers; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idE1886D107C1245D5B018930602255FCA"><enum>(B)</enum><text display-inline="yes-display-inline">otherwise assist in providing medical care
to veterans in highly rural areas.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id730330133AD0403E9D9285611EEA5063"><enum>(4)</enum><header display-inline="yes-display-inline">Maximum
amount</header><text display-inline="yes-display-inline">The amount of a grant
under this section may not exceed $50,000.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id011F4ECE8DE04EBEA57D40AE1693B2F3"><enum>(5)</enum><header display-inline="yes-display-inline">No matching requirement</header><text display-inline="yes-display-inline">The recipient of a grant under this section
shall not be required to provide matching funds as a condition for receiving
such grant.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id1D558A18A21E443D8E817DF96A6D557A"><enum>(b)</enum><header display-inline="yes-display-inline">Regulations</header><text display-inline="yes-display-inline">The Secretary shall prescribe regulations
for—</text>
<paragraph commented="no" display-inline="no-display-inline" id="id878CD4BE75964BCA83A3754C929A8E4C"><enum>(1)</enum><text display-inline="yes-display-inline">evaluating grant applications under this
section; and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id56FD9E24531B49ECAA417B58E1FBAD07"><enum>(2)</enum><text display-inline="yes-display-inline">otherwise administering the program
established by this section.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id3A8266CD65BB42DCAB9AE4BE91FEB503"><enum>(c)</enum><header display-inline="yes-display-inline">Definitions</header><text display-inline="yes-display-inline">In this section:</text>
<paragraph commented="no" display-inline="no-display-inline" id="idA4F081964B554C2EA95257575942D2C7"><enum>(1)</enum><header>Highly
rural</header><text display-inline="yes-display-inline">The term <term>highly
rural</term>, in the case of an area, means that the area consists of a county
or counties having a population of less than seven persons per square
mile.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0731D73B17B24DEA86F5DC40FF9C8BAF"><enum>(2)</enum><header>Veterans service
organization</header><text display-inline="yes-display-inline">The term
<term>veterans service organization</term> means any organization recognized by
the Secretary of Veterans Affairs for the representation of veterans under
section 5902 of title 38, United States Code.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idD7FDF8EAB6AD47098163D2D4529718F3"><enum>(d)</enum><header display-inline="yes-display-inline">Authorization of
appropriations</header><text display-inline="yes-display-inline">There are
authorized to be appropriated $3,000,000 for each of fiscal years 2010 through
2014 to carry out this section.</text>
</subsection></section><enum>III</enum><header>Other health care
matters</header>
<section id="idB8F2762831B3474FBBBE242FD011C123"><enum>301.</enum><header>Expansion of veteran
eligibility for reimbursement by Secretary of Veterans Affairs for emergency
treatment furnished in a non-Department facility</header>
<subsection id="HB54775BAC0F5492EADB56D625EA43679"><enum>(a)</enum><header>Expansion of
eligibility</header><text display-inline="yes-display-inline">Subsection
(b)(3)(C) of section 1725 is amended by striking <quote>, in whole or in
part,</quote>.</text>
</subsection><subsection id="ID9d585ac42d2340319b0ab05b21ba0e76"><enum>(b)</enum><header>Limitations on
reimbursement</header><text>Section 1725 is further amended—</text>
<paragraph id="ID2a3dfeaa28154839a5404a69eca52f63"><enum>(1)</enum><text>in subsection (c), by
adding at the end the following new paragraph:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idED2DF4CAF02A4D6AA668E950280E1AC9" reported-display-style="italic" style="OLC">
<paragraph id="ID910c1deb29434d9e8ee1c810091dbbde" indent="up1"><enum>(4)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id0F57FD7F64FA43F1A69EDB080A1996BD"><enum>(A)</enum><text>If the veteran has
contractual or legal recourse against a third party that would, in part,
extinguish the veteran’s liability to the provider of the emergency treatment
and payment for the treatment may be made both under subsection (a) and by the
third party, the amount payable for such treatment under such subsection shall
be the amount by which the costs for the emergency treatment exceed the amount
payable or paid by the third party, except that the amount payable may not
exceed the maximum amount payable established under paragraph (1)(A).</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idC2DE52F951554EA19DEF09E7C94E38BE" indent="up1" reported-display-style="italic"><enum>(B)</enum><text>In any case in which a
third party is financially responsible for part of the veteran’s emergency
treatment expenses, the Secretary shall be the secondary payer.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idFB7A208218C94943B117E492A6746006" indent="up1" reported-display-style="italic"><enum>(C)</enum><text>A payment in the amount
payable under subparagraph (A) shall be considered payment in full and shall
extinguish the veteran’s liability to the provider.</text>
</subparagraph><subparagraph changed="added" committee-id="SSVA00" id="idB48D6A75A4244BA7B7ADAC98080EADA6" indent="up1" reported-display-style="italic"><enum>(D)</enum><text>The Secretary may not
reimburse a veteran under this section for any copayment or similar payment
that the veteran owes the third party or for which the veteran is responsible
under a health-plan contract.</text>
</subparagraph></paragraph><after-quoted-block>;
and</after-quoted-block></quoted-block>
</paragraph><paragraph id="ID4861e31e50fa46c7a61b033349a1df8d"><enum>(2)</enum><text>in subsection
(f)(3)—</text>
<subparagraph id="id91664962210145BF9F2C79C726881891"><enum>(A)</enum><text>in subparagraph (A), by
inserting before the period at the end the following: <quote>, including the
Secretary of Health and Human Services with respect to the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) and the
Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.)</quote>;
and</text>
</subparagraph><subparagraph id="id94CC1E210F244C3AAB5EB9D1B1846F77"><enum>(B)</enum><text>in subparagraph (B), by
inserting before the period at the end the following: <quote>, including a
State Medicaid agency with respect to payments made under a State plan for
medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et
seq.)</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="H3B82CB1C0B4E4911B0CA7CE0FEC546AA"><enum>(c)</enum><header>Effective date</header>
<paragraph id="idAF0F0489A3FA499F8CACA6B47DE2B49C"><enum>(1)</enum><header>In
general</header><text display-inline="yes-display-inline">The amendments made
by subsections (a) and (b) shall take effect on the date of the enactment of
this Act, and shall apply with respect to emergency treatment furnished on or
after that date.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id103847CDAB0E457DB7454916AAAB68CD"><enum>(2)</enum><header>Reimbursement for
treatment before effective date</header><text>The Secretary of Veterans Affairs
may provide reimbursement under section 1725 of title 38, United States Code,
as amended by this subsection, for emergency treatment furnished before the
date of the enactment of this Act if the Secretary determines that, under the
circumstances applicable with respect to the veteran, it is appropriate to do
so.</text>
</paragraph></subsection></section><section id="id8D80CD6EA0B442DDA8697E96BAFDFDB0"><enum>302.</enum><header>Prohibition on
collection of copayments from veterans who are catastrophically
disabled</header>
<subsection id="id150387F5510D42BF9A02BA98E8C8406C"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Subchapter III of
chapter 17 is amended by adding at the end the following new section:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idDA7CE3C4845C451482A630D853B2AFEA" reported-display-style="italic" style="USC">
<section id="idC0A21D939546495FBE7AD51E680DE37A"><enum>1730A.</enum><header>Prohibition on
collection of copayments from catastrophically disabled veterans</header><text display-inline="no-display-inline">Notwithstanding subsections (f) and (g) of
section 1710 and section 1722A(a) of this title or any other provision of law,
the Secretary may not require a veteran who is catastrophically disabled to
make any copayment for the receipt of hospital care or medical services under
the laws administered by the
Secretary.</text>
</section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id0BBFEF39E6A3499B87644E6F506C8950"><enum>(b)</enum><header>Clerical
amendment</header><text>The table of sections at the beginning of such chapter
is amended by inserting after the item relating to section 1730 the following
new item:</text>
<quoted-block changed="added" committee-id="SSVA00" display-inline="no-display-inline" id="idBF27B166E6BF4781A999AD5914829920" reported-display-style="italic" style="OLC">
<toc changed="added" committee-id="SSVA00" reported-display-style="italic">
<toc-entry bold="off" level="section">1730A. Prohibition on
collection of copayments from catastrophically disabled
veterans.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><enum>IV</enum><header>Construction and naming
matters</header>
<section id="id3B96B91DDEBB4A628A489518781269CF" section-type="subsequent-section"><enum>401.</enum><header>Major medical
facility project Department of Veterans Affairs Medical Center, Walla Walla,
Washington</header>
<subsection id="id41F2A5B0C44A465F8E316B010423FE61"><enum>(a)</enum><header>Authorization for major
medical facility project</header><text>The Secretary of Veterans Affairs may
carry out a major medical facility project for the construction of a new
multiple specialty outpatient facility, campus renovation and upgrades, and
additional parking at the Department of Veterans Affairs Medical Center, Walla
Walla, Washington, with the project to be carried out in an amount not to
exceed $71,400,000.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id150EB91CB7AB4CA68F3BF4F3278F62AD"><enum>(b)</enum><header>Authorization of
appropriations</header><text>There is authorized to be appropriated to the
Secretary of Veterans Affairs for fiscal year 2010 for the Construction, Major
Projects account, $71,400,000 for the project authorized in subsection
(a).</text>
</subsection></section><section id="idD9D0C0FC4C914F65A8AC19BB0793CDDD" section-type="subsequent-section"><enum>402.</enum><header>Merril Lundman
Department of Veterans Affairs Outpatient Clinic</header>
<subsection id="idBC6BD5947DD24926AAD1B953346F8634"><enum>(a)</enum><header>In
general</header><text>The Department of Veterans Affairs outpatient clinic in
Havre, Montana, shall after the date of the enactment of this Act be known and
designated as the <quote>Merril Lundman Department of Veterans Affairs
Outpatient Clinic</quote>.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="id07DBC90BFE6B4F97ADA30ADAB0F50E44"><enum>(b)</enum><header>References</header><text>Any
reference in any law, regulation, map, document, record, or other paper of the
United States to the outpatient clinic referred to in subsection (a) shall be
considered to be a reference to the Merril Lundman Department of Veterans
Affairs Outpatient Clinic.</text>
</subsection></section>Amend the title so as to read:
A Bill to amend title 38, United States Code, to provide assistance to
caregivers of veterans, to improve the provision of health care to veterans in
rural areas, and for other purposes.
.
September 25, 2009
Reported with an amendment and an amendment to the
title